Using the Score for Trauma Triage for Geriatric and Middle-aged (STTGMA) to Cluster High-Risk Hip Fracture Patients for Hospice Discharge

Q2 Medicine

Journal of Clinical Orthopaedics and Trauma Pub Date : 2025-10-01 DOI:10.1016/j.jcot.2025.103225

Benjamin Hammond , Danielle Olson , Abhishek Ganta , Kenneth Egol , Sanjit Konda

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引用次数: 0

Abstract

Background

Hip fracture patients may be hospice candidates if life expectancy is < 6 months. This study evaluates STTGMAHIP FX's ability to identify high-risk hip fracture patients for hospice discharge at emergency room presentation to guide end-of-life care planning.

Methods

A retrospective analysis of a prospectively maintained registry of patients aged ≥55 with low-energy hip fractures (2014–2024) was conducted. Patients were stratified by STTGMAHIP FX percentiles: minimal (≤50th), low (50th–<80th), moderate (80th–<97.5th), and high (≥97.5th). Demographics, injury characteristics, treatment, and outcomes were recorded. The primary outcome was identification of Hospice Discharge Candidates (HDCs), defined as discharge to hospice during the index admission, inpatient mortality >48 h after surgery, or mortality <6 months post-operation. American Society of Anesthesiologists (ASA) score was compared to STTGMAHIP FX for the ability to cluster HDCs using area under receiver operating characteristic (AUROC) curve analysis and a two-proportion Z-test.

Results

Among 2777 patients (mean age 81.18 ± 9.80 years), HDC incidence rose with STTGMAHIP FX risk level: 2.9% (minimal risk), 5.9% (low risk), 14.2% (moderate risk), and 29.6% (high risk) (p < 0.05). Only 17.0% of patients classified as ASA 4 were HDCs. Additionally, STTGMAHIP FX demonstrated a slightly better ability to discriminate HDCs compared to ASA, although not statistically significant (0.719 vs 0.683; p = 0.138). However, the STTGMAHIP FX high risk stratification was much more useful in identifying HDCs than ASA (29.6% vs 17.0%; p = 0.013).

Conclusion

STTGMAHIP FX identifies hospice-eligible hip fracture patients more effectively than ASA. High-risk patients per STTGMAHIP FX demonstrate elevated 6-month mortality and may benefit from early hospice planning at admission.

Abstract Image

查看原文本刊更多论文

利用中老年创伤分诊评分（STTGMA）对髋部骨折高危患者进行临终关怀出院分类

背景：髋部骨折患者如果预期寿命为6个月，可能是安宁疗护的候选者。本研究评估STTGMAHIP FX在急诊室提出临终关怀出院时识别高风险髋部骨折患者的能力，以指导临终关怀计划。方法对年龄≥55岁的低能量髋部骨折患者（2014-2024年）进行回顾性分析。根据STTGMAHIP FX百分位数对患者进行分层：最小（≤50）、低（50 - 80）、中等（80 - 97.5%）和高（≥97.5%）。记录人口统计学、损伤特征、治疗和结果。主要结局是确定临终关怀出院候选者（HDCs），定义为住院期间出院、术后48小时住院死亡率或术后6个月死亡率。采用受试者工作特征（AUROC）曲线下面积分析和双比例z检验，比较美国麻醉医师协会（ASA）评分与STTGMAHIP FX的HDCs聚类能力。结果2777例患者（平均年龄81.18±9.80岁）中，HDC发病率随STTGMAHIP FX风险水平的升高而升高，分别为2.9%（极危）、5.9%（低危）、14.2%（中危）、29.6%（高危）（p < 0.05）。ASA 4级患者中只有17.0%为HDCs。此外，STTGMAHIP FX鉴别HDCs的能力比ASA稍好，但没有统计学意义（0.719 vs 0.683; p = 0.138）。然而，STTGMAHIP FX高风险分层在识别HDCs方面比ASA更有用（29.6% vs 17.0%; p = 0.013）。结论sttgmahip FX识别符合临终关怀条件的髋部骨折患者比ASA更有效。根据STTGMAHIP FX，高风险患者6个月死亡率升高，可能受益于入院时的早期临终关怀计划。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Clinical Orthopaedics and Trauma Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

181

审稿时长

92 days

期刊介绍： Journal of Clinical Orthopaedics and Trauma (JCOT) aims to provide its readers with the latest clinical and basic research, and informed opinions that shape today''s orthopedic practice, thereby providing an opportunity to practice evidence-based medicine. With contributions from leading clinicians and researchers around the world, we aim to be the premier journal providing an international perspective advancing knowledge of the musculoskeletal system. JCOT publishes content of value to both general orthopedic practitioners and specialists on all aspects of musculoskeletal research, diagnoses, and treatment. We accept following types of articles: • Original articles focusing on current clinical issues. • Review articles with learning value for professionals as well as students. • Research articles providing the latest in basic biological or engineering research on musculoskeletal diseases. • Regular columns by experts discussing issues affecting the field of orthopedics. • "Symposia" devoted to a single topic offering the general reader an overview of a field, but providing the specialist current in-depth information. • Video of any orthopedic surgery which is innovative and adds to present concepts. • Articles emphasizing or demonstrating a new clinical sign in the art of patient examination is also considered for publication. Contributions from anywhere in the world are welcome and considered on their merits.