Identifying clinically relevant groups of hip fracture patients at risk of adverse outcomes by using classification tree analysis

SummaryAimTo identify groups of hip fracture patients at risk of adverse outcome by investigating interactions between previously reported risk factors.MethodsA consecutive sample of 338 hip fracture patients was included at admission to the orthopaedic department and followed up 4 months later. Outcomes measured were mortality, failure to regain pre-injury mobility and failure to return home. Data were collected about previously reported risk factors for adverse outcomes in those respects.ResultsThe highest risk of death occured in males living in institutions for the elderly before the fracture (48%). Lowest risk of death had patients admitted from their own home, without malignancy and below 80 years of age (1%). The overall risk of failure to regain pre-injury mobility at the 4 month follow up was 30%. In patients walking independently before the fracture and age above 85 years, the risk increased to 88%. In patients walking with devices before the fracture, the risk of being confined to bed or wheelchair increased from 10% to 20% if the patient was confused. Confusion also increased the risk of relocation from their own home to an institution for the elderly from 19% to 53%.ConclusionThe results of the study can help nurses in making realistic discharge plans based on risk analyses, employing more than just age as risk factor. Using this information nurses can meet the patient’s individual needs in an improved way.