New scoring system at admission to predict walking ability at discharge for patients with hip fracture

Abstract

Introduction: A reliable scoring system that predicts the walking ability of hip fracture patients would be useful for clinicians. Here we developed a scoring system for hip fracture patients and evaluated its predictive ability.

Hypothesis: We hypothesized that age, sex, presence of dementia, walking ability before the injury, fracture type, serum hemoglobin level, serum albumin level and interval in days between admission and surgery would be the predictive factors of the walking ability at discharge.

Material and methods: Data from 409 patients who underwent hip fracture surgery were included. We analyzed factors that affected walking ability and developed a scoring system that predicts the probability of walking unaided or with a cane at discharge.

Results: The mean age of the patients was 81.3 years. A total of 164 (40%) patients could walk unaided or with a cane at discharge. Multivariate logistic regression analysis showed that the obstructive factors for the ability to walk unaided or with a cane at discharge were older age (odds ratio [OR]=0.962, p=0.002), dementia (OR=0.126, p<0.001), use of a cane before injury (OR=0.396, p<0.001), trochanteric fracture (OR=0.571, p=0.027) and low serum albumin level (OR=4.15, p<0.001) at admission. The scoring system used the following formula: Score=5-0.04×age+albumin-2(with dementia)- 1(with use of a cane before injury)-1(with trochanteric fracture). The C-statistics for the scoring system was 0.81 (95% confidence interval, 0.77-0.85).

Discussion: This newly developed scoring system of information at admission predicted the discharge mobility of hip fracture patients. In addition to the previously known risk factors, serum albumin level at admission was detected as a new predictor for mobility at discharge.

Level of proof: IV, retrospective study.

Keywords: Albumin; Hip fracture; Predictive factors; Scoring system; Walking ability.