Abstract
Background: The question of whether patients with hip fracture can be discharged home or require hospital transfer for additional rehabilitation is critical. The same clinical pathway is not suitable for all patients. However, there are no clear indices for establishing the appropriate clinical pathway. To address this, we examined preinjury factors, including the Barthel index (BI), and performed logistic regression analysis to identify factors affecting the outcome (direct home discharge or hospital transfer) of patients with hip fracture. Materials and methods: Patients with hip fracture who underwent surgery at Yokohama City University hospital were consecutively enrolled, and clinical data were retrospectively reviewed. Intergroup (direct home discharge or hospital transfer) comparison was performed using Student’s t test (continuous variables) and Fisher’s exact test (categorical variables). Factors affecting outcome were determined by logistic regression analysis. Receiver operating characteristic (ROC) curve analysis was used to identify the cut-off level, sensitivity, and specificity of the identified factors. Results: The preinjury BI scores for patients discharged home directly were significantly higher (p 79 were difficult to discharge directly home and were more likely to be transferred to another hospital (95.6% sensitivity and 62.9% specificity). Conclusions: Low preinjury BI scores ( 79) indicate a requirement for a co-operative pathway between regional hospitals that ensures a smooth hospital transfer.
Highlights
The incidence of hip fracture is increasing year-on-year due to the aging population and coincident osteoporosis [1]; as such, hip fractures have become a major socioeconomic problem
The decision to initiate hospital transfer or aim for direct home discharge is critical from the standpoint of clinical management, co-operation with regional hospitals, and medical expenses
We investigated preinjury factors, including the Barthel index (BI), and performed logistic regression analysis to identify factors that affect the outcome of patients with hip fracture
Summary
The incidence of hip fracture is increasing year-on-year due to the aging population and coincident osteoporosis [1]; as such, hip fractures have become a major socioeconomic problem. As the population continues to age, and if the incidence of fracture does not change, we will be faced with 250,000 patients per year by 2020 and 300,000 by 2030. Patients with hip fractures necessarily stay in hospital for a long time and frequently require transfer to another satellite hospital. The decision to initiate hospital transfer or aim for direct home discharge is critical from the standpoint of clinical management, co-operation with regional hospitals, and medical expenses. The question of whether patients with hip fracture can be discharged home or require hospital transfer for additional rehabilitation is critical. We examined preinjury factors, including the Barthel index (BI), and performed logistic regression analysis to identify factors affecting the outcome (direct home discharge or hospital transfer) of patients with hip fracture
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