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The Geriatrics at Risk Score (GeRi-Score) for mortality prediction in geriatric patients with proximal femur fracture – a development and validation study from the Registry for Geriatric Trauma (ATR-DGU)

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Abstract

Summary

This study developed an easy-to-use mortality prediction tool, which showed an acceptable discrimination and no significant lack of fit. The GeRi-Score was able to predict mortality and could distinguish between mild, moderate and high risk groups. Therefore, the GeRi-Score might have the potential to distribute the intensity of medical care.

Purpose

Several mortality-predicting tools for hip fracture patients are available, but all consist of a high number of variables, require a time-consuming evaluation and/or are difficult to calculate. The aim of this study was to develop and validate an easy-to-use score, which depends mostly on routine data.

Methods

Patients from the Registry for Geriatric Trauma were divided into a development and a validation group. Logistic regression models were used to build a model for in-house mortality and to obtain a score. Candidate models were compared using Akaike information criteria (AIC) and likelihood ratio tests. The quality of the model was tested using the area under the curve (AUC) and the Hosmer–Lemeshow test.

Results

38,570 patients were included, almost equal distributed to the development and to the validation dataset. The AUC was 0.727 (95% CI 0.711 – 0.742) for the final model, AIC resulted in a significant reduction in deviance compared to the basic model, and the Hosmer–Lemeshow test showed no significant lack of fit (p = 0.07). The GeRi-Score predicted an in-house mortality of 5.3% vs. 5.3% observed mortality in the development dataset and 5.4% vs. 5.7% in the validation dataset. The GeRi-Score was able to distinguish between mild, moderate and high risk groups.

Conclusions

The GeRi-Score is an easy-to-use mortality-predicting tool with an acceptable discrimination and no significant lack of fit. The GeRi-Score might have the potential to distribute the intensity of perioperative medical care in hip fracture surgery and can be used in quality management programs as benchmark tool.

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Role of Registry for Geriatric Trauma (ATR-DGU)

Registry for Geriatric Trauma (ATR-DGU): The host of the Registry for Geriatric Trauma is the AUC—Academy for Trauma Surgery (AUC). According to the publication guideline, it is desirable to list the Registry for Geriatric Trauma (ATR-DGU) as a co-author. According to the guideline, it should read "… and the Registry for Geriatric Trauma" or "… on behalf of the Registry for Geriatric Trauma". Daniel Schmitz is the senior author of the manuscript.

Registry for Geriatric Trauma (ATR-DGU)10 support-atr@auc-online.de

10Working Committee on Geriatric Trauma Registry of the German Trauma Society (DGU), Berlin, Germany

Author information

Authors and Affiliations

  1. Department of Orthopedic and Emergency Surgery, Alfried Krupp Hospital, Hellweg 100, 45276, Essen, Germany

    Carsten Schoeneberg, Laura Heuser, Sven Lendemans & Bastian Pass

  2. AUC, Academy for Trauma Surgery (AUC), Munich, Germany

    Katherine Rascher

  3. Medical Faculty, University of Zurich, Zurich, Switzerland

    Matthias Knobe

  4. Medical Faculty, RWTH Aachen University Hospital, 52074, Aachen, Germany

    Matthias Knobe

  5. Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany

    Daphne Eschbach

  6. Department for Trauma Surgery, Klinikum Hochsauerland, Arnsberg, Germany

    Benjamin Buecking

  7. Department of Orthopedics and Trauma Surgery, Marienhospital, Stuttgart, Germany

    Ulrich Liener

  8. Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU, Munich, Germany

    Carl Neuerburg

  9. Department of Trauma, Orthopedic and Hand Surgery, Marienhospital Bottrop, Bottrop, Germany

    Daniel Schmitz

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  1. Carsten Schoeneberg
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on behalf of the Registry for Geriatric Trauma (ATR-DGU)

Corresponding author

Correspondence to Carsten Schoeneberg.

Ethics declarations

Ethics approval

Ethical Vote was obtained from the ethics commission at the university of Marburg (AZ 46/16).

Consent to participate

A written consent of the patients to participate in the ATR-DGU is obtained from the participating clinics. Without this, an entry into the register is not possible.

Consent for publication

No personal data, which can be assigned to a person, will be published. For this type of study, formal consent is not required.

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Schoeneberg, C., Heuser, L., Rascher, K. et al. The Geriatrics at Risk Score (GeRi-Score) for mortality prediction in geriatric patients with proximal femur fracture – a development and validation study from the Registry for Geriatric Trauma (ATR-DGU). Osteoporos Int 34, 879–890 (2023). https://doi.org/10.1007/s00198-023-06719-5

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