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Charlson Comorbidity Indices and In-hospital Deaths in Patients with Hip Fractures

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

The Charlson Comorbidity Index (CCI) and its modifications are comorbidity-based measures that predict mortality. It was developed for patients without trauma and inconsistently predicted mortality and adverse events in several previous studies of patients with trauma.

Purpose

We therefore (1) determined whether the three different CCIs were predictors for in-hospital deaths in patients with hip fractures, (2) verified if the CCI mortality prediction had changed with time, (3) evaluated other predictors of in-hospital death in patients with hip fractures, and (4) determined if the CCI has predicted in-hospital adverse events.

Methods

We retrospectively reviewed a nationwide probability sample survey, the National Hospital Discharge Survey. More than 6 million adult patients with hip fractures and their associated comorbidities were scored by the original 1987 CCI, the 1994 age-adjusted CCI, and the 2011 updated, reweighted CCI. The three mortality indices’ predictive values and predictors of in-hospital adverse events were compared.

Results

For patients with hip fractures, all three CCI variations predicted in-hospital mortality. The receiver operating curves (ROC) of the models were less than 0.68, but they improved when we used statistical models that included age, sex, concomitant injuries, and other comorbidities not contained in the CCI models (ROC > 0.74). The age-adjusted CCI accuracy was slightly better than the other two CCIs. Adverse events during hospital stays were associated with a higher CCI, pertrochanteric fracture (versus transcervical), abdominal, chest, or head trauma, atrial fibrillation, multiple fractures, female sex, and longer hospital stays; however, the accuracy of this model was poor (ROC = 0.65).

Conclusions

While all three CCI variations predicted in-hospital mortality in patients with hip fractures, other factors may be of value in patients with trauma.

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Authors and Affiliations

  1. Orthopaedic Hand and Upper Extremity Service, Yawkey Center, Massachusetts General Hospital, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA

    Valentin Neuhaus MD, John King BA, Michiel G. Hageman MD & David C. Ring MD, PhD

Authors
  1. Valentin Neuhaus MD
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  2. John King BA
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  3. Michiel G. Hageman MD
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  4. David C. Ring MD, PhD
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Corresponding author

Correspondence to David C. Ring MD, PhD.

Additional information

One of the authors certifies that he (VN) has or may receive payments or benefits, during the study period, an amount of more than $10,000 from Gottfried und Julia Bangerter-Rhyner-Stiftung, Switzerland, for Scientific Research. One of the authors certifies that he (MGH) has or may receive payments or benefits, during the study period, an amount of more than $10,000 from Marti Keuning Eckhardt Stichting, The Netherlands, for Scientific Research. One of the authors certifies that he (DCR) has or may receive payments or benefits, during the study period, an amount of less than $10,000 from Skeletal Dynamics LLC (Miami, FL, USA) and Wright Medical Technology, Inc (Arlington, TN, USA).

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved or waived approval for the human protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research.

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Neuhaus, V., King, J., Hageman, M.G. et al. Charlson Comorbidity Indices and In-hospital Deaths in Patients with Hip Fractures. Clin Orthop Relat Res 471, 1712–1719 (2013). https://doi.org/10.1007/s11999-012-2705-9

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  • DOI: https://doi.org/10.1007/s11999-012-2705-9

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