Skip to main content

Advertisement

SpringerLink
Log in

The Penrod score: a prognostic instrument to balance an increasing geriatric fracture caseload with diminishing health care resources?

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Geriatric hip fracture patients are a highly heterogeneous collective, what distinctly aggravates the best possible treatment. Consequently, it is becoming more important to identify selection criteria that can distinguish those patients who can benefit the most from treatment in a geriatric fracture center. In our pilot study, we assessed the 2007 published Penrod score for its utility as a useful selection tool by prospectively comparing our own patient’s outcome with the Penrod study.

Methods

77 patients treated for geriatric hip fracture were preoperatively classified according to the Penrod score. Patients were divided into three clusters by age (1: <75 years, 2: 75–84 years, 3: ≥85 years). Clusters 2 and 3 were then classified according to their ability to perform activities of daily living (ADL’s) and cognitive status (presence or absence of dementia). In 51 out of these 77 patients, the ability to perform ADLs could be assessed 6 months postoperatively and was compared with the Penrod scores.

Results

58 % of cluster 1 patients were able to perform 4 ADLs independently 6 months postoperatively (52.9 % Penrod study). In clusters 2A and 3A, 48 and 50 %, respectively, were able to perform 4 ADLs independently, compared with 40.6 and 31.5 % (Penrod collective). 22 % of our patients in 2B performed all ADLs independently (3.6 % Penrod) and 25 % in cluster 3B (9.4 % Penrod).

Conclusion

Our preliminary results support the prognostic value of the Penrod score in the treatment of geriatric hip fracture patients. With the help of the Penrod score, it may be possible to identify patients, who are expected to significantly profit from an intensified treatment in a geriatric fracture center (clusters 2B, 3A, and 3B). By utilizing this score, improved outcomes and simultaneously a more effective utilization of valuable health care resources could be achieved.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Saltzherr TP, Borghans HJ, Bakker RH, Go PM (2006) Proximal femur fractures in the elderly in The Netherlands during the period 1991–2004: incidence, mortality, length of hospital stay and an estimate of the care capacity needed in the future. Ned Tijdschr Geneeskd 150(47):2599–2604

    CAS  PubMed  Google Scholar 

  2. Svedbom A, Ivergard M, Hernlund E, Rizzoli R, Kanis JA (2014) Epidemiology and economic burden of osteoporosis in Switzerland. Arch Osteoporos 9:187. doi:10.1007/s11657-014-0187-y

    Article  CAS  PubMed  Google Scholar 

  3. Leibson CL, Tosteson AN, Gabriel SE, Ransom JE, Melton LJ (2002) Mortality, disability, and nursing home use for persons with and without hip fracture: a population-based study. J Am Geriatr Soc 50(10):1644–1650

    Article  PubMed  Google Scholar 

  4. Farahmand BY, Michaelsson K, Ahlbom A, Ljunghall S, Baron JA, Swedish Hip Fracture Study G (2005) Survival after hip fracture. Osteoporos Int 16 (12):1583–1590. doi:10.1007/s00198-005-2024-z

  5. Cannada LK, Hill BW (2014) Osteoporotic hip and spine fractures: a current review. Geriatr Orthop Surg Rehabil 5(4):207–212. doi:10.1177/2151458514548579

    Article  PubMed  PubMed Central  Google Scholar 

  6. Magaziner J, Hawkes W, Hebel JR, Zimmerman SI, Fox KM, Dolan M, Felsenthal G, Kenzora J (2000) Recovery from hip fracture in eight areas of function. J Gerontol A Biol Sci Med Sci 55(9):M498–M507

    Article  CAS  PubMed  Google Scholar 

  7. Bonar SK, Tinetti ME, Speechley M, Cooney LM (1990) Factors associated with short- versus long-term skilled nursing facility placement among community-living hip fracture patients. J Am Geriatr Soc 38(10):1139–1144

    Article  CAS  PubMed  Google Scholar 

  8. Gonzalez-Zabaleta J, Pita-Fernandez S, Seoane-Pillado T, Lopez-Calvino B, Gonzalez-Zabaleta JL (2015) Comorbidity as a predictor of mortality and mobility after hip fracture. Geriatr Gerontol Int. doi:10.1111/ggi.12510

    PubMed  Google Scholar 

  9. Penrod JD, Litke A, Hawkes WG, Magaziner J, Doucette JT, Koval KJ, Silberzweig SB, Egol KA, Siu AL (2008) The association of race, gender, and comorbidity with mortality and function after hip fracture. J Gerontol A Biol Sci Med Sci 63(8):867–872

    Article  PubMed  PubMed Central  Google Scholar 

  10. Smith T, Pelpola K, Ball M, Ong A, Myint PK (2014) Pre-operative indicators for mortality following hip fracture surgery: a systematic review and meta-analysis. Age Ageing 43(4):464–471. doi:10.1093/ageing/afu065

    Article  PubMed  Google Scholar 

  11. Friedman SM, Mendelson DA, Bingham KW, Kates SL (2009) Impact of a comanaged Geriatric Fracture Center on short-term hip fracture outcomes. Arch Intern Med 169(18):1712–1717. doi:10.1001/archinternmed.2009.321

    Article  PubMed  Google Scholar 

  12. Mendelson DA, Friedman SM (2014) Principles of comanagement and the geriatric fracture center. Clin Geriatr Med 30(2):183–189. doi:10.1016/j.cger.2014.01.016

    Article  PubMed  Google Scholar 

  13. Suhm N, Kaelin R, Studer P, Wang Q, Kressig RW, Rikli D, Jakob M, Pretto M (2014) Orthogeriatric care pathway: a prospective survey of impact on length of stay, mortality and institutionalisation. Arch Orthop Trauma Surg 134(9):1261–1269. doi:10.1007/s00402-014-2057-x

    Article  CAS  PubMed  Google Scholar 

  14. Penrod JD, Litke A, Hawkes WG, Magaziner J, Koval KJ, Doucette JT, Silberzweig SB, Siu AL (2007) Heterogeneity in hip fracture patients: age, functional status, and comorbidity. J Am Geriatr Soc 55(3):407–413. doi:10.1111/j.1532-5415.2007.01078.x

    Article  PubMed  Google Scholar 

  15. Hannan EL, Magaziner J, Wang JJ, Eastwood EA, Silberzweig SB, Gilbert M, Morrison RS, McLaughlin MA, Orosz GM, Siu AL (2001) Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. JAMA 285(21):2736–2742

    Article  CAS  PubMed  Google Scholar 

  16. Suhm N, Rikli D, Schaeren S, Studer P, Jakob M, Kates SL (2010) Recent aspects on outcomes in geriatric fracture patients. Osteoporos Int 21(Suppl 4):S523–S528. doi:10.1007/s00198-010-1397-9

    Article  CAS  PubMed  Google Scholar 

  17. Merten H, Johannesma PC, Lubberding S, Zegers M, Langelaan M, Jukema GN, Heetveld MJ, Wagner C (2015) High risk of adverse events in hospitalised hip fracture patients of 65 years and older: results of a retrospective record review study. BMJ Open 5(9):e006663. doi:10.1136/bmjopen-2014-006663

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bellelli G, Mazzola P, Morandi A, Bruni A, Carnevali L, Corsi M, Zatti G, Zambon A, Corrao G, Olofsson B, Gustafson Y, Annoni G (2014) Duration of postoperative delirium is an independent predictor of 6-month mortality in older adults after hip fracture. J Am Geriatr Soc 62(7):1335–1340. doi:10.1111/jgs.12885

    Article  PubMed  Google Scholar 

  19. Prestmo A, Hagen G, Sletvold O, Helbostad JL, Thingstad P, Taraldsen K, Lydersen S, Halsteinli V, Saltnes T, Lamb SE, Johnsen LG, Saltvedt I (2015) Comprehensive geriatric care for patients with hip fractures: a prospective, randomised, controlled trial. Lancet 385(9978):1623–1633. doi:10.1016/S0140-6736(14)62409-0

    Article  PubMed  Google Scholar 

  20. Koval KJ, Skovron ML, Aharonoff GB, Zuckerman JD (1998) Predictors of functional recovery after hip fracture in the elderly. Clin Orthop Relat Res 348:22–28

    PubMed  Google Scholar 

  21. Magaziner J, Simonsick EM, Kashner TM, Hebel JR, Kenzora JE (1990) Predictors of functional recovery 1 year following hospital discharge for hip fracture: a prospective study. J Gerontol 45(3):M101–M107

    Article  CAS  PubMed  Google Scholar 

  22. Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, McCloskey EV, Jonsson B, Kanis JA (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8:136. doi:10.1007/s11657-013-0136-1

  23. Lippuner K, Golder M, Greiner R (2005) Epidemiology and direct medical costs of osteoporotic fractures in men and women in Switzerland. Osteoporos Int 16(Suppl 2):S8–S17. doi:10.1007/s00198-004-1696-0

    Article  PubMed  Google Scholar 

  24. Lippuner K (2012) Epidemiology and burden of osteoporosis in Switzerland. Ther Umsch 69(3):137–144. doi:10.1024/0040-5930/a000266

    Article  PubMed  Google Scholar 

  25. Marcantonio ER, Flacker JM, Michaels M, Resnick NM (2000) Delirium is independently associated with poor functional recovery after hip fracture. J Am Geriatr Soc 48(6):618–624

    Article  CAS  PubMed  Google Scholar 

  26. Givens JL, Sanft TB, Marcantonio ER (2008) Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. J Am Geriatr Soc 56(6):1075–1079. doi:10.1111/j.1532-5415.2008.01711.x

    Article  PubMed  Google Scholar 

  27. Garbharran U, Chinthapalli S, Hopper I, George M, Back DL, Dockery F (2013) Red cell distribution width is an independent predictor of mortality in hip fracture. Age Ageing 42(2):258–261. doi:10.1093/ageing/afs176

    Article  PubMed  Google Scholar 

  28. Lv H, Zhang L, Long A, Mao Z, Shen J, Yin P, Li M, Zeng C, Zhang L, Tang P (2015) Red cell distribution width as an independent predictor of long-term mortality in hip fracture patients: a prospective cohort study. J Bone Miner Res. doi:10.1002/jbmr.2597

    PubMed  Google Scholar 

  29. Drevet S, Bioteau C, Maziere S, Couturier P, Merloz P, Tonetti J, Gavazzi G (2014) Prevalence of protein-energy malnutrition in hospital patients over 75 years of age admitted for hip fracture. Orthop Traumatol Surg Res 100(6):669–674. doi:10.1016/j.otsr.2014.05.003

    Article  CAS  PubMed  Google Scholar 

  30. Goisser S, Schrader E, Singler K, Bertsch T, Gefeller O, Biber R, Bail HJ, Sieber CC, Volkert D (2015) Malnutrition according to mini nutritional assessment is associated with severe functional impairment in geriatric patients before and up to 6 months after hip fracture. J Am Med Dir Assoc 16(8):661–667. doi:10.1016/j.jamda.2015.03.002

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Department of Orthopaedics and Traumatology, Geriatric fracture Center, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland

      Sebastian Müller, Hatem al-Fadel Saleh, Marcel Jakob, Bojana Savic, Daniel Rikli & Norbert Suhm

    2. Clinic for Orthopaedics and Trauma Surgery, University Hospital Heidelberg, Schlierbacher Landstrasse 200A, 69118, Heidelberg, Germany

      Nicholas A. Beckmann

    Authors
    1. Sebastian Müller
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Hatem al-Fadel Saleh
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Marcel Jakob
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Nicholas A. Beckmann
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Bojana Savic
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Daniel Rikli
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Norbert Suhm
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Sebastian Müller.

    Ethics declarations

    Conflict of interest

    NS. declares the following disclosures: he is consultant for Roche, Eli Lilly, MSD, Synthes as well as the AO foundation. Until 2007, he holds an employment with the AO. All other authors declare that they have no conflict of interest.

    Additional information

    S. Müller and H. Saleh contributed equally to this study.

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Müller, S., Saleh, H.aF., Jakob, M. et al. The Penrod score: a prognostic instrument to balance an increasing geriatric fracture caseload with diminishing health care resources?. Arch Orthop Trauma Surg 136, 1099–1106 (2016). https://doi.org/10.1007/s00402-016-2477-x

    Download citation

    • Received:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s00402-016-2477-x

    Keywords

    Search

    Navigation