Predictive capacity of 30-day mortality using the Nottingham Scale in people aged 65 years or older with hip fracture in Michoacán
Main Article Content
Keywords
Hip Fractures, Mortality, Risk Assessment, Frailty, Delirium
Abstract
Abstract
Background: Hip fracture is a high-morbidity and high-mortality event in older adults. Early identification of the risk of death allows for optimized therapeutic decisions.
Objective: To evaluate the predictive capacity of the Nottingham Hip Fracture Scale (NHFS) for estimating 30-day mortality in individuals aged 65 years or older with a hip fracture.
Material and methods: A prospective, observational, longitudinal study was conducted in two IMSS hospitals in Michoacán, Mexico. Patients aged 65 years or older with a hip fracture were included. The NHFS score and its discriminative capacity were calculated using receiver operating characteristic (ROC) curve analysis.
Results: 169 patients were included; the 30-day mortality rate was 14.2%. Hemoglobin < 10 g/dL showed the strongest association with mortality, followed by in-hospital delirium and the NHFS score. In the multivariable model, severe anemia remained an independent predictor. The discriminative capacity of the scale was moderate (AUC = 0.746). The optimal cutoff point was ≥ 5 points.
Conclusions: The Nottingham scale showed moderate discriminatory ability to predict 30-day mortality. Severe anemia emerged as an independent predictor of mortality.
References
1. Fernández MA, Ferguson RJ, et al. Hip fracture epidemiology and outcomes in the aging population: updated global trends. Lancet Healthy Longev. 2023;4(2):e98–e108. doi: 10.1016/S2666-7568(22)00303-6
2. Søgaard AJ, Meyer HE, et al. Burden of fragility fractures and mortality trends in older adults 2010–2022. J Bone Miner Res. 2023;38(5):812–821. doi: 10.1002/jbmr.4770
3. García-Hermoso A, Cavero-Redondo I, et al. Global hip fracture mortality burden 1990–2021. Lancet Glob Health. 2024;12(2):e235–e245. doi: 10.1016/S2214-109X(23)00509-1
4. Simunovic N, Devereaux PJ, et al. Early surgery for hip fracture reduces mortality: updated meta-analysis. CMAJ. 2022;194(12):E423–E431. doi: 10.1503/cmaj.211208
5. Collinge CA, Duke D, et al. Timing of surgery and mortality in hip fracture. J Orthop Trauma. 2022;36(4):e137–e144. doi: 10.1097/BOT.0000000000002300
6. Cooper SA, Orman M, et al. Osteoporosis and hip fracture mortality: updated 2024 review. Osteoporos Int. 2024;35(1):45–59. doi: 10.1007/s00198-023-06880-y
7. Maxwell MJ, Moran CG, et al. Nottingham Hip Fracture Score: contemporary predictive performance. Br J Anaesth. 2021;126(3):585–593. doi: 10.1016/j.bja.2020.11.016
8. Kristensen PK, Ofstad EH, et al. Predicting 30-day mortality after hip fracture: updated models. J Clin Epidemiol. 2024;173:111439. doi: 10.1016/j.jclinepi.2024.111439
9. Ferro FC, Campos MAG, et al. NHFS performance in Brazilian older adults with hip fracture. Sci Rep. 2025;15:5607. doi: 10.1038/s41598-025-89869-2
10. Serrano-Lugo MA, Luján-Hernández I, et al. Validation of the NHFS in Mexican population. Rev Esp Geriatr Gerontol. 2025;60(3):101610. doi: 10.1016/j.regg.2024.101610
11. Perera A, Zampieri FG, et al. Predictive performance of clinical scores in older adults with hip fracture. Age Ageing. 2024;53(1):afae010. doi: 10.1093/ageing/afae010
12. Forssten MP, Ismail A, et al. Mortality burden of frailty in hip fracture patients. Eur J Trauma Emerg Surg. 2023;49(3):1467–1475. doi: 10.1007/s00068-022-02204-6
13. Zhang Y, Wang L, et al. Frailty and post-fracture mortality: systematic review 2023. Osteoporos Int. 2023;34(3):415–429. doi: 10.1007/s00198-022-06568-8
14. Penfold RS, Farrow L, et al. Delirium on admission and mortality following hip fracture. Bone Joint J. 2025;107-B(4):470–478. doi: 10.1302/0301-620X.107B4.BJJ-2024-1164.R1
15. Ogawa T, Shoda N, et al. Infections after hip fracture and impact on mortality. J Hosp Infect. 2023;134:10–18. doi: 10.1016/j.jhin.2023.01.011
16. Cheng H, Li H, et al. Postoperative myocardial infarction after hip fracture: predictors and outcomes. J Am Heart Assoc. 2024;13(1):e033210. doi: 10.1161/JAHA.123.033210
17. Guerra MT, Ribeiro TA, et al. Multimorbidity and risk of complications in hip fracture. Injury. 2022;53(2):573–580. doi: 10.1016/j.injury.2021.12.037
18. Hsu WWQ, Zhang X, et al. Cardiovascular phenotypes and temporal risk after hip fracture. Nat Commun. 2024;15:4353. doi: 10.1038/s41467-024-48713-3
19. Lee HD, Lee YJ, et al. Preoperative anemia and mortality after hip fracture. Injury. 2023;54(6):1521–1528. doi: 10.1016/j.injury.2023.02.042
20. Shoda N, Ogawa T, et al. Predictors of 30-day mortality in older adults with hip fracture during hospitalization. J Orthop Surg Res. 2022;17:522. doi: 10.1186/s13018-022-03388-z
21. Cao L, Li C, et al. Impact of delirium on postoperative mortality: hip fracture cohort. BMC Geriatr. 2022;22:906. doi: 10.1186/s12877-022-03582-8
22. Contreras CM, et al. Comprehensive geriatric assessment and outcomes in hip fracture. J Am Med Dir Assoc. 2024;25(1):67–74.doi: 10.1016/j.jamda.2023.08.014
23. Roche JJ, Wenn RT, Sahota O, et al. Comorbidity and postoperative complications on short-term mortality after hip fracture. BMJ. 2021;375:e066834. doi: 10.1136/bmj-2021-066834
24. Walsh ME, Hjelholt TJ, et al. Sex differences in mortality after hip fracture: systematic review 2024. J Am Geriatr Soc. 2024;72(8):2150–2161. doi: 10.1111/jgs.18356
25. Araiza AM, et al. Fragility fractures in Latin America: clinical outcomes and mortality. Arch Osteoporos. 2023;18(1):45. doi: 10.1007/s11657-023-01222-0
Article Sidebar
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors retain their copyright and grant the Revista Médica del IMSS the right of first publication. Articles are distributed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which allows sharing as long as the author and the original source are properly credited.