Machine learning-based prediction of short- and long-term mortality for shared decision-making in older hip fracture patients: the Dutch Hip Fracture Audit algorithms in 74,396 cases.
Hidde Dijkstra, Cathleen S Parsons, Hanne-Eva VAN Bremen, Hanna C Willems, Anne A H De Hond, Barbara C Van Munster, Job N Doornberg, Jacobien H F Oosterhoff
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引用次数: 0
Abstract
Background and purpose: Treatment-related shared decision-making (SDM) in older adults with hip fractures is complex due to the need to balance patient-specific factors such as life goals, frailty, and surgical risks. It includes considerations such as prognosis and decisions concerning whether to operate or not on frail, life-limited patients. We aimed to develop machine learning (ML)-driven prediction models for short- and long-term mortality in a large cohort of patients with hip fractures.
Methods: In this national registry-based retrospective cohort study, patients aged ≥ 70 years registered in the nationwide Dutch Hip Fracture Audit from 2018-2023 were included. Predictive variables were selected based on the literature and/or clinical relevance. 6 ML algorithms, including logistic regression, were trained with internal cross-validation and evaluated on discrimination (c-statistic), sensitivity, specificity, calibration, and interpretability.
Results: 74,396 patients (median age 84, IQR 78-89; 68% female) were analyzed. Most patients lived at home (69%) and high malnutrition risk was seen in 10%. 18% had dementia. Mortality rates were 9.1% (30-day), 15% (90-day), and 26% (1-year). Logistic regression performed comparably to other algorithms, but was chosen as the preferred algorithm due to its superior interpretability (c-statistic: 30-day 0.82, 90-day 0.81, 1-year 0.80).
Conclusion: We developed and validated ML algorithms, including logistic regression, for mortality prediction in older hip fracture patients with adequate performance. This information may inform SDM.
期刊介绍:
Acta Orthopaedica (previously Acta Orthopaedica Scandinavica) presents original articles of basic research interest, as well as clinical studies in the field of orthopedics and related sub disciplines. Ever since the journal was founded in 1930, by a group of Scandinavian orthopedic surgeons, the journal has been published for an international audience. Acta Orthopaedica is owned by the Nordic Orthopaedic Federation and is the official publication of this federation.