Chin-on-Chest in Neck of Femur Fracture (COCNOF) sign: A simple radiographic predictor of frailty and mortality in hip fracture patients |
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| Institution: | 1. Trauma and Orthopaedics registrar, James Cook University Hospital, United Kingdom;2. Hip Specialist Nurse practitioner, James Cook University Hospital, United Kingdom;3. Consultant Trauma and Orthopaedic Surgeon, James Cook University Hospital, United Kingdom;1. Department of Orthopedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan;2. Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan;3. Department of Orthopedic Surgery, National Taiwan University Hospital, Taipei, Taiwan;;4. School of Medicine, National Taiwan University, Taipei, Taiwan.;1. Department of Radiology, Shandong Provincial Corps Hospital of Chinese People''s Armed Police Force, Jinan 250014, China;2. Department of Ultrasonography, Shandong Provincial Qianfoshan Hospital, The First Hospital Affiliated to Shandong First Medical University, Jinan 250014, China;3. Department of Radiology, Affiliated Hospital of Binzhou Medical University, Binzhou 256600, China;1. Sports Injury Center, Ring Road, Safdarjung Enclave, New Delhi 110029, India;2. Promhex Multispecialty Hospital, Omega 1, Greater Noida, Uttar Pradesh, India;3. Department of Orthopaedic Surgery, Maulana Azad Medical College and Associated Lok Nayak Hospital, 13, Bahadur Shah Zafar Marg, New Delhi 110002, India |
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| Abstract: | IntroductionFragility fractures are a significant public health challenge often occurring as a result of frailty. Identifying patients who have increased risk of adverse outcomes can aid treating teams in managing these patients appropriately. We hypothesise that the appearance of the patient's head overlapping the lung fields (named Chin on Chest in Neck of Femur sign (COCNOF)) in the admission chest radiograph was a predictor of increased mortality at 3, 6 and 12 months.MethodsAll consecutive patients admitted with hip fracture between 1st January – 31st December 2019 were analysed. We collected patient characteristics, AMTS score, ASA grade, length of stay, place of discharge, Nottingham Hip Fracture Score, Rockwood Frailty score, Charlson Comorbidity Index and presence of COCNOF sign. The main outcome measures were mortality at 90 days, six months and 12 months following admission.Results469 patients with a mean age of 81.9 (SD 8.4) were included. 18% of patients were COCNOF positive. Univariate analysis showed positive COCNOF sign to be associated with higher mortality at 90 days (19.1 vs 10.8%; RR 1.95, 95%CI 1.05 – 3.63,p=0.03), six months (31.5% vs 14.2%; RR 2.77, 95%CI 1.62 – 4.72, p<0.001) and twelve months (41.6% vs 17.1%; RR 3.45, 95%CI 1.62-4.72, p<0.001). In the multivariate regression models the strongest predictors of mortality were age, gender and CCI it is therefore likely that the COCNOF sign is acting as a surrogate marker of these variables within the univariate models.ConclusionOur results suggest that COCNOF sign is a simple radiographic marker which can be used to identify patients with higher levels of frailty and increased risk of mortality following hip fracture. |
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