The clinical frailty scale as a predictor of orthopaedic outcomes: a narrative review.

INTRODUCTION: The Clinical Frailty Scale (CFS) is a 9-point scaling system used to categorise the frailty of patients. The CFS is well-established as a prognostic tool for decision-making within healthcare settings. However, the relationship between the CFS as a predictor for orthopaedic outcomes is limited. This review aims to provide an overview of the efficacy of the CFS as a prognostic tool for predicting orthopaedic outcomes. METHODS: Systematic review using PRISMA checklist (PROSPERO registered: CRD42023456648). Ovid and PubMed databases were searched using defined search terms to identify English language papers between 2007 and June 2023 which fit the inclusion criteria. Abstract screening was carried out independently and included studies proceeded to full-text review. RESULTS: 10 studies were identified. Studies used a range of outcome measures to assess success, including gross outcomes like mortality rates, as well as more specific functional outcomes, such as joint functionality scores. Studies identified that higher CFS scores correlate to poorer outcomes within orthopaedic patients. These include higher rates of mortality (41.7 % at one-year post proximal femur fracture for CFS ≥ 7), longer length of hospital stay and increased risk of adverse events post-procedure (both increased linearly from CFS 1 to 4). Additionally, the CFS was shown to be a strong prognostic tool when compared to other frailty scales. The number of studies that evaluated the relationship between the CFS and joint functionality scores is limited. CONCLUSION: Higher CFS scores are associated with poorer orthopaedic outcomes. However, it is difficult to quantify the true impact due to the limited number of high-quality studies. Further work to characterise the relationship between both gross and functional outcomes associated with the utilisation of the CFS in orthopaedic settings is essential to ascertain the utility of this simple score to improve resource allocation and provide effective consent to patients.

The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip.

Aims: Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. Methods: We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. Results: The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). Conclusion: The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH.

COVID-19 in older people: a rapid clinical review.

INTRODUCTION: the COVID-19 pandemic poses a high risk to older people. The aim of this article is to provide a rapid overview of the COVID-19 literature, with a specific focus on older adults. We frame our findings within an overview of the disease and have also evaluated the inclusion of older people within forthcoming clinical trials. METHODS: we searched PubMed and bioRxiv/medRxiv to identify English language papers describing the testing, treatment and prognosis of COVID-19. PubMed and bioRxiv/medRxiv searches took place on 20 and 24 March 2020, respectively. RESULTS: screening of over 1,100 peer-reviewed and pre-print papers yielded n = 22 on COVID-19 testing, n = 15 on treatment and n = 13 on prognosis. Viral polymerase chain reaction (PCR) and serology are the mainstays of testing, but a positive diagnosis may be increasingly supported by radiological findings. The current evidence for the effectiveness of antiviral, corticosteroid and immunotherapies is inconclusive, although trial data are largely based on younger people. In addition to age, male gender and comorbidities, specific laboratory and radiology findings are important prognostic factors. Evidence suggests that social distancing policies could have important negative consequences, particularly if in place for an extended period. CONCLUSION: given the established association between increasing age and poor prognosis in COVID-19, we anticipate that this rapid review of the current and emergent evidence might form a basis on which future work can be established. Exclusion of older people, particularly those with comorbidities, from clinical trials is well recognised and is potentially being perpetuated in the field of current COVID-19 research.