Mr Seth Tarrant

© 2014 The British Editorial Society of Bone & Joint Surgery. There is a high rate of mortality in elderly patients who sustain a fracture of the hip. We aimed to determine the rate of preventable mortality and errors during the management of these patients. A 12 month prospective study was performed on patients aged > 65 years who had sustained a fracture of the hip. This was conducted at a Level 1 Trauma Centre with no orthogeriatric service. A multidisciplinary review of the medical records by four specialists was performed to analyse errors of management and elements of preventable mortality. During 2011, there were 437 patients aged > 65 years admitted with a fracture of the hip (85 years (66 to 99)) and 20 died while in hospital (86.3 years (67 to 96)). A total of 152 errors were identified in the 80 individual reviews of the 20 deaths. A total of 99 errors (65%) were thought to have at least a moderate effect on death; 45 reviews considering death (57%) were thought to have potentially been preventable. Agreement between the panel of reviewers on the preventability of death was fair. A larger-scale assessment of preventable mortality in elderly patients who sustain a fracture of the hip is required. Multidisciplinary review panels could be considered as part of the quality assurance process in the management of these patients.

Copyright © 2014 by Lippincott Williams & Wilkins. BACKGROUND: The Denver and Sequential Organ Failure Assessment (SOFA) scores have been used widely to describe the epidemiology of postinjury multiple-organ failure; however, differences in these scores make it difficult to compare incidence, duration, and mortality of multiple-organ failure. The study aim was to compare the performance of the Denver and SOFA scores with respect to the outcomes of mortality, intensive care unit length of stay (ICU LOS), and ventilator days.METHODS: A 60-month prospective epidemiologic study was undertaken at an Australian Level I trauma center. Data were collected on trauma patients that met inclusion criteria (ICU admission, Injury Severity Score [ISS] 9 15, age 9 18 years, head Abbreviated Injury Scale [AIS] score G 3, survival for 948 hours). Demographics, ISS, physiologic parameters, SOFA and Denver scores, and outcome data were prospectively collected. Sensitivity/specificity and receiver operating characteristic curve were calculated for both scores. Analysis was also completed for a Day 3 postinjury SOFA and Denver score.RESULTS: A total of 140 patients met the inclusion criteria (mean [SD] age, 47 [21] years; ISS, 30; male, 69%; mortality rate, 6%; mean [SD] ICU LOS, 9 [7] days; mean [SD] ventilation period, 6 [7] days). There was no difference in the score performance predicting mortality. Day 3 SOFA score of 4 or greater outperformed the Denver score of greater than 3 when predicting ICU LOS and ventilator days (area under the curve, 0.83 vs. 0.69, 0.86 vs. 0.73, respectively). The SOFA score was more sensitive and the Denver score was more specific when predicting mortality, ICU LOS, and ventilator days.CONCLUSION: Both scores had similar performance predicting mortality; however, the Day 3 SOFA score outperforms the Denver score when predicting ICU LOS and ventilator days. Either score could be superior based on whether one is seeking to optimize specificity or sensitivity. It is important to note that these findings are in a non-head-injured population and that there are practical difficulties using the SOFA in head-injured patients.LEVEL OF EVIDENCE: Diagnostic study, level II.