the shortcoming and deficiency in “risk factors for complications and in‑hospital mortality...
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Arch Orthop Trauma SurgDOI 10.1007/s00402-014-2025-5
LeTTer TO The eDITOr
The shortcoming and deficiency in “Risk factors for complications and in‑hospital mortality following hip fractures: a study using the National Trauma Data Bank”
Yueju Liu · Yingze Zhang
received: 4 May 2014 © Springer-Verlag Berlin heidelberg 2014
Secondly, the averaged age of patients in this study was 72.7 years old, which means that most of these are elderly patients. Such elderly patients is generally prevalent of cognitive impairment [4, 5]. As we know, the cognitive impairment was the significant risk factors for mortality in recently years [6]. In this study, it was lack of this impor-tant indicator, which was a serious flaw.
Thirdly, the hip fractures in the elderly patients usu-ally belonged to low energy injury, which appeared in this article as 43,474 blunt injury, left 890 “other” mechanism of injury. however, when mentioned to the injury severity score (ISS), there were 1,909 patients belonged to serious injury, with ISS scores between 25 and 75. Did the 890 patients of “other” injury mechanism were high energy injury? As we usually divided the mechanism of injury in hip fracture into high energy and low energy injury (blunt injury), so if we attribute the 890 patients to high energy injury with high ISS score (25–75), why there were 1,909 patients with ISS score (25–75). We are waiting for the author’s interpretation of confusion.
Conflict of interest The authors confirm that there are no known conflicts of interest associated with this publication and that there has been no significant financial support for this work that could have influenced its outcome.
References
1. Belmont PJ Jr, Garcia eJ, romano D, Bader JO, Nelson KJ, Sch-oenfeld AJ (2014) risk factors for complications and in-hospi-tal mortality following hip fractures: a study using the National Trauma Data Bank. Arch Orthop Trauma Surg 134:597–604
2. Chobanian AV, Bakris GL, Black hr, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, roc-cella eJ (2004) Seventh report of the Joint National Committee on Prevention, Detection, evaluation, and Treatment of high Blood Pressure. hypertension 42:1206–1252
To the editor,
Belmont and colleagues [1] have done a lot of work on risk factors for complications and in-hospital mortality follow-ing hip fractures, which was the first study to postulate pre-dictors of morbidity and mortality following hip fracture in a US national model with a large sample. But we feel that this work done too rough and there were many short-comings and deficiencies which we want to share with the author.
Firstly, the medical co-morbidities were simply listed as hypertension, obesity, respiratory disease, malignancy, dia-betes, dialysis and cardiac disease. This is a very unscien-tific, because each diseases can be divided into subgroups according to their different levels of severity. For exam-ple, hypertension can be divided into stage 1 hyperten-sion, stage 2 hypertension and isolated systolic hyperten-sion respectively [2]. So nearly all the current studies of hip fractures used a variety of indicators, such as coexist-ent disease, the functional comorbidity index, the Charn-ley classification and, the American Society of Anesthesi-ologists Scores (ASA) an so on, to predicting the impact of medical comorbidities on treatment results [3]. Only in this way, we can unify standards for comparison.
Y. Liu · Y. Zhang (*) Department of Orthopedic Center, Third hospital of hebei Medical University, No. 139 Zi Qiang road, Shijiazhuang, hebei 050051, People’s republic of Chinae-mail: [email protected]
Y. Liu e-mail: [email protected]
Y. Liu · Y. Zhang Key Orthopaedic Biomechanics Laboratory of hebei Province, Shijiazhuang, People’s republic of China
Arch Orthop Trauma Surg
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3. Liu YJ, Xu B, Li ZY, Zhang Q, Zhang YZ (2012) Quantitative score system for the surgical decision on adult femoral neck frac-tures. Orthopedics 35:e137–e143
4. Watne LO, Torbergsen AC, Conroy S, engedal K, Frihagen F, hjorthaug GA, Juliebo V, raeder J, Saltvedt I, Skovlund e, Wyller TB (2014) The effect of a pre- and postoperative ortho-geriatric service on cognitive function in patients with hip frac-ture: randomized controlled trial (Oslo Orthogeriatric Trial). BMC Med 12:63
5. Parsons N, Griffin XL, Achten J, Costa ML (2014) Outcome assessment after hip fracture: is eQ-5D the answer? Bone Jt res 3:69–75
6. Sullivent ee, Faul M, Wald MM (2011) reduced mortality in injured adults transported by helicopter emergency medical ser-vices. Prehosp emerg Care 15:295–302