Study validates tool to assess mortality risk in older patients with orthopedic fractures

March 6, 2018, NYU Langone Health

Analytic software developed by orthopedic trauma surgeons at NYU Langone Health accurately identifies which middle-aged and elderly patients face a greater mortality risk following surgery for an orthopedic fracture, according to a new study.

PersonaCARE is a unique, predictive deep-learning software that uses an algorithm called the "Score for Trauma Triage in the Geriatric and Middle Aged (STTGMA)," which has been previously validated in research. In this latest study, investigators looked at whether adding markers of frailty could improve risk assessment and enhance the software's ability to predict outcomes, such as risk of , postsurgical complications or other adverse events. After comparing the original and modified versions, researchers found no significant difference in terms of predicting inpatient mortality.

These findings are being presented Tuesday, March 6, 2018, in poster session at the American Academy of Orthopaedic Surgeons (AAOS) 2018 Annual Meeting in New Orleans. The findings were also published in the December 2017 issue of Geriatric Orthopaedic Surgery & Rehabilitation.

"PersonaCARE can better inform health care providers and families on mortality risk after an orthopedic trauma, helping them collaboratively make better care decisions that are in the best interest of patients," says Sanjit R. Konda, MD, an assistant professor of orthopedic surgery in the division of trauma surgery at NYU School of Medicine and director of Geriatric Orthopedic Trauma at NYU Langone Health. "Geriatric inpatients with a higher mortality risk also typically incur additional resources and more than double the hospital costs of patients with lower mortality risk. Identifying potential problems early can help rein in these costs."

How the Study Was Conducted

Frailty is a syndrome described as an overall decline in health from illness or trauma, and is thought to be an important predictor of surgical outcomes in elderly patients. However, there is no consensus on the best assessment tool to assess frailty. Previous research has shown that geriatric trauma is an increasing epidemic in the United States, as "baby boomers" age; people are living longer and are more active than ever before, but because of this, they are sustaining more injuries. Trauma has risen to the seventh-leading cause of death in the U.S. in adults 65 years of age and older.

Konda and the trauma surgery team at NYU Langone Orthopedic Hospital created the PersonaCARE software to evaluate four major physiologic criteria: age, medical comorbidities, vital signs and anatomic injuries. It calculates a score from zero to 100 to determine a patient's mortality risk. Previous retrospective research by Konda's team, collected at a level-one trauma center over a five-year-period, provided evidence to support the algorithm's predictive abilities—but questions remained about which frailty markers should be factored in to better assess patients' mortality risk.

The new study examined 1,486 patients age 55 and over who presented to the emergency rooms of a level-one center, a tertiary care referral center, and an orthopedic specialty hospital urgent care with an orthopedic or spine fracture between September 2014 and September 2016. Of these, 993 cases were considered "low-energy," such as a ground-level fall less than or equal to two stairs, and 492 were "high-energy," equivalent to more serious traumas such as a fall from a greater height or a motor vehicle accident.

They calculated scores with the PersonaCARE software using the original algorithm and the modified version containing additional markers of frailty: existing disability; need of an assistive device to move around; and malnutrition.

There were 23 high-energy inpatient mortalities (4.7 percent of patients) and 20 low-energy inpatient mortalities (2.0 percent). When the original algorithm was used, a computational analysis of predictive accuracy found that the high-energy and low-energy cohorts had a score of 0.926 and 0.896, respectively. For the tool that included frailty indicators, the high-energy and low-energy cohorts were 0.905 and 0.937, respectively—reflecting no meaningful statistical difference in predictive capabilities.

At NYU Langone Orthopedic Hospital, the PersonaCARE software is currently used for all hip fracture patients who are undergoing a hip replacement or operative fixation. Future research will look at the integration of this software with hospital accounting data and with the electronic medical record and what impact that might have on early intervention and care pathways.

"PersonaCARE can calculate a upon hospital admission that can be used as a triage tool to guide older patients who face higher risks of complications and adverse events toward specialized pathways of care," says senior study author Kenneth A. Egol, MD, professor of orthopedic surgery and chief of the Division of Trauma Surgery at NYU Langone.

NYU Langone has developed a commercial version of the PersonaCARE software based on the algorithm used in the study.

Explore further: Older adults who are frail more likely to have negative outcomes after trauma

More information: Sanjit R. Konda et al, How Does Frailty Factor Into Mortality Risk Assessment of a Middle-Aged and Geriatric Trauma Population?, Geriatric Orthopaedic Surgery & Rehabilitation (2017). DOI: 10.1177/2151458517735202

Related Stories

Older adults who are frail more likely to have negative outcomes after trauma

September 6, 2017
Frailty is associated with negative outcomes among older patients who suffered trauma, a new study has found.

Identifying frailty in older patients can predict adverse outcomes after surgery

February 20, 2018
Identifying frailty in surgical patients, especially those without apparent disability, will help predict risk of adverse events and repeat hospitalizations, according to research in CMAJ (Canadian Medical Association Journal).

Patients with head injuries do better when treated by trauma centers, even if it means bypassing other hospitals

March 1, 2018
Patients who sustain severe head injuries tend to have better outcomes if they are taken to a designated trauma center, but 44 percent of them are first taken to hospitals without these specialized care capabilities, according ...

Frailty can help predict complications, death in older trauma patients

June 11, 2014
Measuring frailty using the Frailty Index (FI) can be a predictor of in-hospital complications, need for discharge to a skilled nursing facility or in-hospital death in older patients following physical trauma.

Age is not a risk factor for complications after surgery among older patients

January 12, 2018
Among older patients, frailty and cognitive impairment before surgery are associated with developing complications after surgery, but age is not, a new study suggests.

Older adults who are frail more likely to experience delirium after surgery

January 26, 2018
Older adults who are frail are twice as likely to experience delirium following elective surgery than those of an older age, a new study suggests.

Recommended for you

First human test of robotic eye surgery a success

June 18, 2018
Researchers from the University of Oxford have completed the first successful trial of robot-assisted retinal surgery.

Surgical blood transfusions tied to clot risk

June 13, 2018
(HealthDay)—Blood transfusions around the time of surgery may raise your risk for dangerous blood clots, researchers say.

Tonsil and adenoid removal associated with respiratory, allergic and infectious disease

June 7, 2018
Tonsil and adenoid removal associated with long-term risks of respiratory, allergic and infectious diseases Removing tonsils and adenoids in childhood increases the long-term risk of respiratory, allergic and infectious diseases, ...

Clues found to early lung transplant failure

May 21, 2018
Among organ transplant patients, those receiving new lungs face a higher rate of organ failure and death compared with people undergoing heart, kidney and liver transplants. One of the culprits is inflammation that damages ...

In breakthrough, surgeon builds windpipes from arteries

May 20, 2018
Where others failed, sometimes spectacularly, French surgeon Emmanuel Martinod has helped people whose windpipes have been ravaged by cancer and other diseases to live and breathe normally again.

Blood type O patients may have higher risk of death from severe trauma

May 1, 2018
Blood type O is associated with high death rates in severe trauma patients, according to a study published in the open access journal Critical Care that involved 901 Japanese emergency care patients.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.