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.
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.
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).
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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Marks R. Hip fracture epidemiological trends, outcomes, and risk factors, 1970–2009. Int J Gen Med. 2010;3:1–17.
Veronese N, Maggi S. Epidemiology and social costs of hip fracture. Injury. 2018;49:1458–60.
Schuijt HJ, Kusen J, van Hernen JJ, van der Vet P, Geraghty O, Smeeing DPJ, et al. Orthogeriatric trauma unit improves patient outcomes in geriatric hip fracture patients. Geriatr Orthop Surg Rehabil. 2020. https://doi.org/10.1177/2151459320949476.
Grigoryan KV, Javedan H, Rudolph JL. Orthogeriatric care models and outcomes in hip fracture patients: a systematic review and meta-analysis. J Orthop Trauma. 2014;28:e49-55.
Parker MJ, Todd CJ, Palmer CR, Camilleri-Ferrante C, Freeman CJ, Laxton CE, et al. Inter-hospital variations in length of hospital stay following hip fracture. Age Ageing. 1998;27:333–7.
Brasel KJ, Rasmussen J, Cauley C, Weigelt JA. Reasons for delayed discharge of trauma patients. J Surg Res. 2002;107:223–6.
Foss NB, Palm H, Krasheninnikoff M, Kehlet H, Gebuhr P. Impact of surgical complications on length of stay after hip fracture surgery. Injury. 2007;38:780–4.
Bentler SE, Liu L, Obrizan M, Cook EA, Wright KB, Geweke JF, et al. The aftermath of hip fracture: discharge placement, functional status change, and mortality. Am J Epidemiol. 2009;170:1290–9.
Mathew PJ, Jehan F, Kulvatunyou N, Khan M, O’Keeffe T, Tang A, et al. The burden of excess length of stay in trauma patients. Am J Surg. 2018;216:881–5.
Garcia AE, Bonnaig JV, Yoneda ZT, Richards JE, Ehrenfeld JM, Obremskey WT, et al. Patient variables which may predict length of stay and hospital costs in elderly patients with hip fracture. J Orthop Trauma. 2012;26:620–3.
Parker MJ, Palmer CR. A new mobility score for predicting mortality after hip fracture. J Bone Joint Surg Br. 1993;75:797–8.
Nanjayan SK, John J, Swamy G, Mitsiou K, Tambe A, Abuzakuk T. Predictors of change in “discharge destination” following treatment for fracture neck of femur. Injury. 2014;45:1080–4.
Richards T, Glendenning A, Benson D, Alexander S, Thati S. The independent patient factors that affect length of stay following hip fractures. Ann R Coll Surg Engl. 2018;100:556–62.
Salar O, Baker PN, Forward DP, Ollivere BJ, Weerasuriya N, Moppett IK, et al. Predictors of direct home discharge following fractured neck of femur. Ann R Coll Surg Engl. 2017;99:444–51.
Kristensen MT, Foss NB, Ekdahl C, Kehlet H. Prefracture functional level evaluated by the New Mobility Score predicts in-hospital outcome after hip fracture surgery. Acta Orthop. 2010;81:296–302.
von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9.
Saklad M. Grading of patients for surgical procedures. Anesthesiology. 1941;2:281–4.
Kass GV. An exploratory technique for investigating large quantities of categorical data. J R Stat Soc Ser C (Appl Stat). 1980;29:119–27.
Sathiyakumar V, Thakore R, Greenberg SE, Dodd AC, Obremskey W, Sethi MK. Risk factors for discharge to rehabilitation among hip fracture patients. Am J Orthop. 2015;44:E438–43.
de Pablo P, Losina E, Phillips CB, Fossel AH, Mahomed N, Lingard EA, et al. Determinants of discharge destination following elective total hip replacement. Arthritis Rheum. 2004;51:1009–17.
Barsoum WK, Murray TG, Klika AK, Green K, Miniaci SL, Wells BJ, et al. Predicting patient discharge disposition after total joint arthroplasty in the United States. J Arthroplasty . 2010;25:885–92.
Kimmel LA, Holland AE, Edwards ER, Cameron PA, De Steiger R, Page RS, et al. Discharge destination following lower limb fracture: development of a prediction model to assist with decision making. Injury. 2012;43:829–34.
Sivasundaram L, Tanenbaum JE, Mengers SR, Trivedi NN, Su CA, Salata MJ, et al. Identifying a clinical decision tool to predict discharge disposition following operative treatment of hip fractures in the United States. Injury. 2020;51:1015–20.
Oldmeadow LB, McBurney H, Robertson VJ, Kimmel L, Elliott B. Targeted postoperative care improves discharge outcome after hip or knee arthroplasty. Arch Phys Med Rehabil. 2004;85:1424–7.
Pedersen TJ, Lauritsen JM. Routine functional assessment for hip fracture patients. Acta Orthop. 2016;87:374–9.
Kristensen MT, Bandholm T, Foss NB, Ekdahl C, Kehlet H. High inter-tester reliability of the new mobility score in patients with hip fracture. J Rehabil Med. 2008;40:589–91.
Nicholas J. Geriatric fracture patient: Comprehensive geriatric assessment [Internet]. AO Found, Switz. 2014 [cited 2020 Nov 15]: [1–3 p.]. https://aotrauma.aofoundation.org/-/media/project/aocmf/aotrauma/documents/education_pdf/curriculum/aot_orthogeriatrics_geriatricassessment.pdf
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.
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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
- Predictive modeling
- Discharge disposition
- Hip fracture
- Parker Mobility Score
- Acute rehabilitation
- Hospital length of stay
- Geriatric trauma care