Risk Scoring Models for Patients With Neck of Femur Fractures: Qualitative Systematic Review Assessing 30-Day Mortality and Ease of Use

Purpose: Hip fractures are a common orthopaedic injury affecting a particularly frail and vulnerable patient cohort. They are at risk of many complications, including prolonged length of stay and mortality. Efforts to identify those at high risk may be beneficial. Over 25 risk prediction models are published for patients with hip fractures.
The primary aim of this study was to assess the performance of predictor scores in predicting 30-day mortality. The secondary aim was to assess the ease of use of these systems.

Methods: A qualitative systematic review was performed. A search was conducted on online databases, including PubMed, CINAHL, Clinical Trials.gov, Cochrane, DARE, Embase, SCOPUS, and Web of Science. The terms fragility hip fractures and risk prediction models were utilized while performing the search. These were then expanded using Boolean operators and similar terms. Search results were imported to Covidence. Primary observational studies using one or more hip fracture mortality prediction models and 30-day mortality as an outcome were included. Systematic reviews and studies on specific patient groups defined other medical conditions (eg, COVID-positive or dialysis patients) that were excluded.

Results: 3101 studies were screened following duplicate removal. 34 papers were included in the review, in which 23 scoring systems were reported. Six of these were preoperative and reported in multiple studies. Most demonstrated appropriate fit and fair discrimination. Five of the six preoperative scoring systems examined displayed appropriate ease of use, allowing risk calculation at the time of admission.

Conclusion: Nottingham Hip Fracture Score remains the most extensive reported scoring system and performs fair overall with AUROC (area under the receiver operating characteristic curve of 0.64-0.80 and good fit in calibration across all studies. However, new systems utilize many similar predictors. There is a need for the standardization of publications on scoring systems to allow further systematic review and meta-analyses.

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