TY - JOUR
T1 - Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture
AU - Halm, Ethan A.
AU - Magaziner, Jay
AU - Hannan, Edward L.
AU - Wang, Jason J.
AU - Silberzweig, Stacey B.
AU - Boockvar, Kenneth
AU - Orosz, Gretchen M.
AU - McLaughlin, Mary Ann
AU - Koval, Kenneth J.
AU - Siu, Albert L.
PY - 2003/1/13
Y1 - 2003/1/13
N2 - Background: Hip fracture is associated with significant mortality and disability. Patients who are discharged from the hospital with active clinical problems may have worse outcomes than those patients without active clinical problems. Objective: To assess the frequency and impact of clinical problems at discharge on clinical and functional hip fracture outcomes. Methods: Detailed clinical data were collected from 559 patients in a prospective, multicenter observational cohort study. Active clinical issues (ACIs) on discharge included the following: temperature of 38.3°C or higher, heart rate of more than 100/min or less than 60/min, systolic blood pressure higher than 180 mm Hg or lower than 90 mm Hg, diastolic blood pressure higher than 110 mm Hg or lower than 60 mm Hg, respiratory rate of more than 24/min, oxygen saturation of less than 90%, altered mental status, no oral intake, shortness of breath, chest pain, arrhythmias, or wound infection. New impairments (NIs) included bowel and bladder incontinence, inability to get out of bed, and decubitus ulcer. Outcomes were deaths, readmissions, and functional mobility 60 days after discharge. Results: Overall, 94 patients (16.8%) had 1 or more ACIs, and 229 (41.0%) had 1 or more NIs on discharge. Both ACIs and NIs on discharge were associated with increased risk-adjusted rates of death (odds ratio, 1.8; 95% confidence interval, 1.2-2.8) or readmission (odds ratio, 1.7; 95% confidence interval, 1.2-2.3). The NIs on discharge were also associated with worse functional mobility (P<.004). These relationships persisted in multivariate analyses that controlled for a previously validated, hip fracture-specific risk adjustment measure. Conclusions: Clinicians should consider information about ACIs and NIs when deciding readiness for discharge and planning post-acute care.
AB - Background: Hip fracture is associated with significant mortality and disability. Patients who are discharged from the hospital with active clinical problems may have worse outcomes than those patients without active clinical problems. Objective: To assess the frequency and impact of clinical problems at discharge on clinical and functional hip fracture outcomes. Methods: Detailed clinical data were collected from 559 patients in a prospective, multicenter observational cohort study. Active clinical issues (ACIs) on discharge included the following: temperature of 38.3°C or higher, heart rate of more than 100/min or less than 60/min, systolic blood pressure higher than 180 mm Hg or lower than 90 mm Hg, diastolic blood pressure higher than 110 mm Hg or lower than 60 mm Hg, respiratory rate of more than 24/min, oxygen saturation of less than 90%, altered mental status, no oral intake, shortness of breath, chest pain, arrhythmias, or wound infection. New impairments (NIs) included bowel and bladder incontinence, inability to get out of bed, and decubitus ulcer. Outcomes were deaths, readmissions, and functional mobility 60 days after discharge. Results: Overall, 94 patients (16.8%) had 1 or more ACIs, and 229 (41.0%) had 1 or more NIs on discharge. Both ACIs and NIs on discharge were associated with increased risk-adjusted rates of death (odds ratio, 1.8; 95% confidence interval, 1.2-2.8) or readmission (odds ratio, 1.7; 95% confidence interval, 1.2-2.3). The NIs on discharge were also associated with worse functional mobility (P<.004). These relationships persisted in multivariate analyses that controlled for a previously validated, hip fracture-specific risk adjustment measure. Conclusions: Clinicians should consider information about ACIs and NIs when deciding readiness for discharge and planning post-acute care.
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U2 - 10.1001/archinte.163.1.107
DO - 10.1001/archinte.163.1.107
M3 - Article
C2 - 12523924
AN - SCOPUS:0037434065
SN - 0003-9926
VL - 163
SP - 107
EP - 112
JO - Archives of Internal Medicine
JF - Archives of Internal Medicine
IS - 1
ER -