Performance of the Nottingham Hip Fracture Score and Clinical Frailty Scale as predictors of short and long-term outcomes: a dual-centre 3-year observational study of hip fracture patients

Abstract

Introduction

Hip fractures account for a growing number of hospital admissions worldwide and are associated with significant morbidity and mortality. The Nottingham Hip Fracture Score (NHFS) was developed to help risk-stratify these patients. Frailty is increasingly recognised to be a predictor of adverse outcomes. The aim of this study, using prospectively collected data from two non-specialist UK hospitals, was to report contemporaneous outcomes for patients with a hip fracture and compare the performance of the NHFS with the Clinical Frailty Scale (CFS).

Materials and methods

Data were collected over a 3-year period (2016–2018) from patients admitted with a hip fracture. In-patient and 1-year mortality and length of stay were compared between the NHFS, CFS and other variables. For discrimination to predict mortality, area under the receiver operating characteristic (AUC) curves were produced.

Results

2422 patients (70.6% female), median age 85 (interquartile range 78–90) were included, with 93% undergoing an operation. 30-day mortality was 5.8% and 1-year mortality 23.5%. Average hospital stay was 18.0 days (Standard deviation 13.7). For in-patient mortality AUC for NHFS was 0.69 (95% CI 0.64–0.74) and for CFS 0.63 (0.57–0.69); for 1-year mortality AUC for NHFS was 0.71 (0.68–0.73) and for CFS 0.67 (0.64–0.71). Neither score predicted extended hospital stay.

Conclusion

Both CFS and NHFS predict 1-year survival with similar, moderate discrimination. Future research could explore whether other factors could be combined to allow better risk stratification following a hip fracture to inform patients and clinicians.