Development and Validation of Multivariable Prediction Models for In-Hospital Death, 30-Day Death, and Change in Residence After Hip Fracture Surgery and the “Stratify-Hip” Algorithm

Aicha Goubar, Finbarr Martin, Catherine M Sackley, Nadine E. Foster, Celia L Gregson, Katie Sheehan*, et al

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

1 Citation (Scopus)
13 Downloads (Pure)

Abstract

Background
To develop and validate the stratify-hip algorithm (multivariable prediction models to predict those at low, medium, and high risk across in-hospital death, 30-day death, and residence change after hip fracture).

Methods
Multivariable Fine-Gray and logistic regression of audit data linked to hospital records for older adults surgically treated for hip fracture in England/Wales 2011–14 (development n = 170 411) and 2015–16 (external validation, n = 90 102). Outcomes included time to in-hospital death, death at 30 days, and time to residence change. Predictors included age, sex, pre-fracture mobility, dementia, and pre-fracture residence (not for residence change). Model assumptions, performance, and sensitivity to missingness were assessed. Models were incorporated into the stratify-hip algorithm assigning patients to overall low (low risk across outcomes), medium (low death risk, medium/high risk of residence change), or high (high risk of in-hospital death, high/medium risk of 30-day death) risk.

Results
For complete-case analysis, 6 780 of 141 158 patients (4.8%) died in-hospital, 8 693 of 149 258 patients (5.8%) died by 30 days, and 4 461 of 119 420 patients (3.7%) had residence change. Models demonstrated acceptable calibration (observed:expected ratio 0.90, 0.99, and 0.94), and discrimination (area under curve 73.1, 71.1, and 71.5; Brier score 5.7, 5.3, and 5.6) for in-hospital death, 30-day death, and residence change, respectively. Overall, 31%, 28%, and 41% of patients were assigned to overall low, medium, and high risk. External validation and missing data analyses elicited similar findings. The algorithm is available at https://stratifyhip.co.uk.

Conclusions
The current study developed and validated the stratify-hip algorithm as a new tool to risk stratify patients after hip fracture.
Original languageEnglish
Article numberglad053
Pages (from-to)1659–1668
Number of pages10
JournalJournals of Gerontology - Series A Biological Sciences and Medical Sciences
Volume78
Issue number9
Early online date9 Feb 2023
DOIs
Publication statusPublished - 1 Sept 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s). Published by Oxford University Press on behalf of The Gerontological Society of America.

Keywords

  • stratification
  • classification
  • fracture neck of femur
  • fragility fracture
  • recovery

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