Is the Parker Mobility Score in the older patient with a traumatic hip fracture associated with discharge disposition after surgery? A retrospective cohort study

Abstract

Purpose

The research questions for this study were as follows: (1) is the Parker Mobility Score (PMS) associated with discharge disposition and hospital length of stay (HLOS) of geriatric traumatic hip fracture patients? (2) Can the PMS be incorporated in a decision tree for the prediction of discharge disposition of geriatric traumatic hip fracture patients upon admittance.

Methods

A dual-center retrospective cohort study was conducted at two level II trauma centers. All patients aged 70 years and older with traumatic hip fractures undergoing surgery in 2018 and 2019 were included consecutively (n = 649). A χ2 automatic interaction detection analysis was performed to determine the association of the PMS (and other variables) with discharge disposition and HLOS and predict discharge destination.

Results

The decision tree for discharge disposition classified patients with an overall accuracy of 82.1% and a positive predictive value of 91% for discharge to a rehabilitation facility. The PMS had the second most significant effect on discharge disposition (χ2 = 22.409, p < 0.001) after age (χ2 = 79.094, p < 0.001). Regarding the tree analysis of HLOS, of all variables in the analysis, PMS had the most significant association with HLOS (F = 14.891, p < 0.001). Patients who were discharged home had a mean HLOS of 6.5 days (SD 8.0), whereas patients who were discharged to an institutional care facility had a mean HLOS of 9.7 days (SD 6.4; p < 0.001).

Conclusion

This study shows that the PMS was strongly associated with discharge disposition and HLOS. The decision tree for the discharge disposition of geriatric traumatic hip fracture patients offers a practical solution to start discharge planning upon admittance which could potentially reduce HLOS.

Level of evidence

Level III, diagnostic.

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Correspondence to Jip Quirijn Kusen or Henk Jan Schuijt.

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Conflict of interest

J. Q. Kusen, N. van der Naald, L. van Overeem, P.C.R. van der Vet, D.P.J. Smeeing, H.A.J. Eversdijk, E.J.M.M. Verleisdonk, D. van der Velde, H.J. Schuijt declare that they have no conflict of interest.

Appendix A

Appendix A

Decision model for the emergency department

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Kusen, J.Q., van der Naald, N., van Overeem, L. et al. Is the Parker Mobility Score in the older patient with a traumatic hip fracture associated with discharge disposition after surgery? A retrospective cohort study. Eur J Trauma Emerg Surg (2021). https://doi.org/10.1007/s00068-021-01712-1

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Keywords

  • Predictive modeling
  • Discharge disposition
  • Hip fracture
  • Parker Mobility Score
  • Acute rehabilitation
  • Hospital length of stay
  • Geriatric trauma care