Modification of a Validated Risk Stratification Tool to Characterize Geriatric Hip Fracture Outcomes and Optimize Care in a Post COVID-19 World

• Published in: Journal of orthopaedic trauma
• Main Authors: Konda, Sanjit R, Ranson, Rachel A, Solasz, Sara J, Dedhia, Nicket, Lott, Ariana, Bird, Mackenzie L, Landes, Emma K, Aggarwal, Vinay K, Bosco, 3rd, Joseph A, Furgiuele, David L, Gould, Jason, Lyon, Thomas R, McLaurin, Toni M, Tejwani, Nirmal C, Zuckerman, Joseph D, Leucht, Philipp, Ganta, Abhishek, Egol, Kenneth A
• Format: Journal Article
• Language: English
• Published: United States 01.09.2020
• ISSN: 1531-2291
• DOI: 10.1097/BOT.0000000000001895

1. To demonstrate how a risk assessment tool modified to account for the COVID-19 virus during the current global pandemic is able to provide risk assessment for low-energy geriatric hip fracture patients. 2. To provide a treatment algorithm for care of COVID-19 positive/suspected hip fractures patients that accounts for their increased risk of morbidity and mortality. One academic medical center including 4 level 1 trauma centers, 1 university-based tertiary-care referral hospital, and 1 orthopedic specialty hospital. 1278 patients treated for hip fractures between October 2014 and April 2020, including 136 patients treated during the COVID-19 pandemic between February 1, 2020 and April 15, 2020. The STTGMAORIGINAL score was modified by adding COVID-19 virus as a risk factor for mortality to create the STTGMACOVID score. Patients were stratified into quartiles to demonstrate differences in risk distribution between the scores. Inpatient and 30-day mortality, major, and minor complications. Both STTGMA score and COVID-19 positive/suspected status are independent predictors of inpatient mortality, confirming their use in risk assessment models for geriatric hip fracture patients. Compared to STTGMAORIGINAL where COVID-19 patients are haphazardly distributed among the risk groups and COVID-19 inpatient and 30 days mortalities comprise 50% of deaths in the minimal and low risk cohorts, the STTGMACOVID tool is able to triage 100% of COVID-19 patients and 100% of COVID-19 inpatient and 30 day mortalities into the highest risk quartile, where it was demonstrated that these patients have a 55% rate of pneumonia, a 35% rate of acute respiratory distress syndrome, a 22% rate of inpatient mortality, and a 35% rate of 30 day mortality. COVID-19 patients who are symptomatic on presentation to the ED and undergo surgical fixation have a 30% inpatient mortality rate compared to 12.5% for patients who are initially asymptomatic but later develop symptoms. The STTGMA tool can be modified for specific disease processes, in this case to account for the COVID-19 virus and provide a robust risk stratification tool that accounts for a heretofore unknown risk factor. COVID-19 positive/suspected status portends a poor outcome in this susceptible trauma population and should be included in risk-assessment models. These patients should be considered high risk for perioperative morbidity and mortality. Patients with COVID-19 symptoms on presentation should have surgery deferred until symptoms improve or resolve and should be reassessed for surgical treatment versus definitive nonoperative treatment with palliative care and/or hospice care. Prognostic Level III. See Instructions for Authors for a complete description of Levels of Evidence.