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Objective To assess the predictive value of three scoring systems, namely the American Society of Anesthesiologists (ASA) classification, the Clinical Frailty Scale (CFS), and the Nottingham Hip Fracture Score (NHFS), in predicting mortality among patients with hip fractures. Materials and methods This retrospective cohort study included 628 participants aged 60 years and above who sought treatment at a UK hospital between January 2018 and December 2018. Data on age, gender, mortality, and assessment scores were collected. The area under the curve was calculated for each receiver operator characteristic (ROC). Cross-tabulation was performed to examine the association between various assessment scores and mortality using the chi-square test. Results The mean age was 80.80±11.18 years. Females were 408 (64.97%). Higher CFS (p<0.001) and NHFS (p<0.001) scores were significantly associated with mortality, while the ASA score did not show a significant association (p=0.225). The calculated area under the curve (AUC) values were as follows: 0.71 (95% CI: 0.65 to 0.76) for CFS, 0.46 (95% CI: 0.39 to 0.53) for NHFS, and 0.41 (95% CI: 0.34 to 0.48) for the ASA score. Utilizing a cut-off of ≥6 for CFS, 57 individuals (98.3%) in the 30-day mortality group were correctly identified. Similarly, the ROC analysis determined a ≥5 cut-off for NHFS accurately predicting 50 patients (86.2%) who deceased within 30 days. Applying an ASA ≥3 cut-off resulted in a predictive mortality rate of 56 (96.6%). The NHFS score demonstrated the highest predictive capability for mortality, with patients scoring ≥5 having a significantly higher risk of mortality compared to those with a score <5. Conclusion This study showed robust correlations between high CFS (≥6) and NHFS (≥5), and mortality within the hip fracture patient cohort.
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INTRODUCTION: Pediatric distal radius buckle fractures are commonly encountered in the emergency department (ED) and are considered non-complex and stable injuries. The National Institute for Health and Care Excellence (NICE) guidelines recommend managing these fractures with a soft cast and discharging patients directly from the ED. However, prevailing practices often involve rigid casts and follow-up clinic visits, leading to unnecessary congestion, prolonged waiting times, excessive radiographic examinations, and frequent cast changes, resulting in additional financial burdens on hospitals. METHODS AND MATERIALS: We conducted an initial audit over a 6-month period at Hull University and Teaching Hospitals, reviewing 184 pediatric distal radius fractures, of which 84 were buckle fractures in children under 12 years old. Data on demographics, subsequent clinic visits, treating doctor's grade, additional radiographs, initial and final treatment approaches, and cast change frequency were collected. After the initial audit, NICE guideline compliance was promoted through the education of parents and healthcare providers. A second audit was performed on patients within the following 6-month period. RESULTS: This study assessed the management of pediatric distal radius buckle fractures in a cohort of 84 patients. 39/84 (46.4%) of patients sought medical attention within one week of sustaining the injury, with 33/84 individuals being discharged during their first visit, either by consultants or registrars. Most patients (69/84) required only a single X-ray examination in the ED, while some needed two or three X-rays during their evaluation. However, after implementing NICE guidelines, in the second audit cycle, 62 out of 64 were discharged directly from the ED, with 42 receiving focal rigidity casts (FRCs) removed at home and 10 discharged with simple crepe bandages. Conclusions: This closed-loop audit effectively showcased that adherence to NICE guidelines yielded better patient management by avoiding unnecessary visits, radiographs, and platers. The adoption of the guidelines leads to the conservation of time and resources.