Cardiac Risk Stratification and Protection

Evidence-Based Care of Geriatric Trauma Patients

The doubling of the geriatric population over the next 20 years will challenge the existing health care system. Optimal care of geriatric trauma patients will be of paramount importance to the health care discussion in America. These patients warrant special consideration because of altered anatomy, physiology, and the resultant decreased ability to tolerate the stresses imposed by traumatic insult. Despite increased risk for worsened outcomes, nearly half of all geriatric trauma patients will be cared for at nondesignated trauma centers. Effective communication is crucial in determining goals of care and arriving at what patients would consider a meaningful outcome.

Goldman score, but not Detsky or Lee indices, predicts mortality 6 months after hip fracture

Background

Over the past years, several cardiac risk indices were evaluated and modified, including Goldman, Detsky, and Lee scores. The predictive capacity of these scores in hip fracture patients is lacking. Thus, our objective was to compare the Goldman, Detsky, and Lee scores as predictors of mortality in 6 months after hip fracture.

Methods

We prospectively evaluated 80 consecutive patients with hip fractures, over the age of 65 admitted to an orthopedic ward at Botucatu Medical School. Patient demographic information, Goldman, Detsky and Lee scores were recorded. All patients were followed for 6 months after hip fracture, and mortality was recorded. Multiple logistic regression analyses were performed for mortality prediction.

Results

The mortality rate was 23% after a 6-month follow-up period. Patients who died had advanced age and the majority of them were male. They also had lower values of handgrip strength, and higher values of creatinine and urea. In the multiple logistic regression models when adjusted by age, gender, handgrip strength and creatinine, Goldman’s score (OR:3.025; 95%CI:1.022-8.953; p:0.046), but not Detsky (OR:2.328; 95%CI:0.422-12.835; p:0.332) and Lee (OR:1.262; 95%CI:0.649-2.454; p:0.494), was associated with mortality 6 months after hip fracture. Each 1 category increase in Goldman score increased the mortality to more than 3-fold.

Conclusions

In conclusion, our data suggest that Goldman score, but not Detsky or Lee indices, predicts mortality associated with hip fracture at up to 6 months post-injury.

The prevention and treatment of dislocation following total hip arthroplasty: efforts to date and future strategies

Dislocation continues as one of the common complications following primary Total Hip Arthroplasty (THA). Considering revision THA, dislocation is also one of the leading causes of failure and the subsequent need for re-revision surgery. This article aims to highlight the efforts to date that surgeons have utilised together with the implants employed to both prevent and treat THA dislocation. A fundamental principal in the management of THA instability is identification of the risk factors for dislocation and these are considered in 5 subgroups; patient factors, surgeon factors, implant design, implant orientation and soft tissue factors. Risk stratification is proposed as a future method of deciding upon best treatment for those patients most at danger of THA dislocation and subsequent continued instability.