Predicting survival after treatment for fracture of the proximal femur and the effect of delays to surgery

J Clin Epidemiol. 2003 Aug;56(8):788-95. doi: 10.1016/s0895-4356(03)00129-x.


Background and objectives: The aim of this study was to evaluate the prognosis after treatment for femoral neck fracture, to assess the impact of delay to surgery, and to devise a clinical prediction rule and score.

Methods: A prospective observational study was conducted in which 1780 patients treated surgically in two teaching hospitals between 1 November 1997 and 31 October 1999 were followed over 12 months. Logistic regression was used to distinguish the effects of predictor variables on survival. Using a probit transformation of the predicted posterior probabilities of death, a prognostic score was devised with scores constrained so that a nominal score of approximately 90 represented a 50:50 chance of survival over 12 months.

Results: Mortality was 30.1% in men and 19.5% in women. Increasing age, male gender, longer pre-operative delay, a higher American Society of Anesthesiology score, a lower Mental Test score, and a lower activities of daily living (Barthel) score were associated with increased risks of death. Of those waiting between 1 and 5 days for surgery, approximately 8 medium-risk and 17 high-risk patients (with prognostic scores of 90 and 120, respectively) would have to have their delay reduced to < 24 hours to yield one additional survivor.

Conclusion: The application of prediction rules must be guided by ethical, social, and scientific concerns.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Activities of Daily Living
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Female
  • Femoral Neck Fractures / mortality*
  • Femoral Neck Fractures / surgery*
  • Humans
  • Logistic Models
  • Male
  • Mental Competency
  • Middle Aged
  • Probability
  • Prognosis
  • Prospective Studies
  • Sex Factors
  • Survival Rate
  • Time Factors