{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T02:05:18Z","timestamp":1783821918975,"version":"3.55.0"},"reference-count":42,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>The aim of the current investigation was to compare the ability of several frailty scores to predict adverse outcomes in hip fracture patients. All adult patients (18 years or older) who suffered a hip fracture due to a fall and underwent surgical fixation were extracted from the 2019 National Inpatient Sample (NIS) Database. A combination of logistic regression and bootstrapping was used to compare the predictive ability of the Orthopedic Frailty Score (OFS), the Nottingham Hip Fracture Score (NHFS), the 11-factor modified Frailty Index (11-mFI) and 5-factor (5-mFI) modified Frailty Index, as well as the Johns Hopkins Frailty Indicator. A total of 227,850 patients were extracted from the NIS. In the prediction of in-hospital mortality and failure-to-rescue (FTR), the OFS surpassed all other frailty measures, approaching an acceptable predictive ability for mortality [AUC (95% CI): 0.69 (0.67\u20130.72)] and achieving an acceptable predictive ability for FTR [AUC (95% CI): 0.70 (0.67\u20130.72)]. The NHFS demonstrated the highest predictive ability for predicting any complication [AUC (95% CI): 0.62 (0.62\u20130.63)]. The 11-mFI exhibited the highest predictive ability for cardiovascular complications [AUC (95% CI): 0.66 (0.64\u20130.67)] and the NHFS achieved the highest predictive ability for delirium [AUC (95% CI): 0.69 (0.68\u20130.70)]. No score succeeded in effectively predicting venous thromboembolism or infections. In summary, the investigated frailty scores were most effective in predicting in-hospital mortality and failure-to-rescue; however, they struggled to predict complications.<\/jats:p>","DOI":"10.3390\/jpm14060621","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T10:08:43Z","timestamp":1718014123000},"page":"621","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Comparative Analysis of Frailty Scores for Predicting Adverse Outcomes in Hip Fracture Patients: Insights from the United States National Inpatient Sample"],"prefix":"10.3390","volume":"14","author":[{"given":"Maximilian Peter","family":"Forssten","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro 701 82, Sweden"},{"name":"School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3552-9153","authenticated-orcid":false,"given":"Yang","family":"Cao","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, 701 82 Orebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Mohammad Ismail","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lakshika","family":"Tennakoon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Spain","sequence":"additional","affiliation":[{"name":"Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahin","family":"Mohseni","sequence":"additional","affiliation":[{"name":"School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden"},{"name":"Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi P.O. Box 11001, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,10]]},"reference":[{"key":"ref_1","first-page":"CD007125","article-title":"Multidisciplinary Rehabilitation for Older People with Hip Fractures","volume":"11","author":"Handoll","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1007\/PL00004148","article-title":"World-Wide Projections for Hip Fracture","volume":"7","author":"Gullberg","year":"1997","journal-title":"Osteoporos. Int. J. Establ. Result Coop. Eur. Found. Osteoporos. Natl. Osteoporos. Found. USA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"15","DOI":"10.4103\/0019-5413.73656","article-title":"Epidemiology of Hip Fracture: Worldwide Geographic Variation","volume":"45","author":"Dhanwal","year":"2011","journal-title":"Indian J. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1080\/17453674.2019.1680485","article-title":"Postoperative Mortality after a Hip Fracture over a 15-Year Period in Denmark: A National Register Study","volume":"91","author":"Gundel","year":"2020","journal-title":"Acta Orthop."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e000778","DOI":"10.1136\/tsaco-2021-000778","article-title":"Postoperative Mortality in Hip Fracture Patients Stratified by the Revised Cardiac Risk Index: A Swedish Nationwide Retrospective Cohort Study","volume":"6","author":"Forssten","year":"2021","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1007\/s00068-022-02204-6","article-title":"The Mortality Burden of Frailty in Hip Fracture Patients: A Nationwide Retrospective Study of Cause-Specific Mortality","volume":"49","author":"Forssten","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg. Off. Publ. Eur. Trauma Soc."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1007\/s00068-023-02356-z","article-title":"The Relationship and Predictive Value of Dementia and Frailty for Mortality in Patients with Surgically Managed Hip Fractures","volume":"50","author":"Ioannidis","year":"2023","journal-title":"Eur. J. Trauma Emerg. Surg. Off. Publ. Eur. Trauma Soc."},{"key":"ref_8","unstructured":"(2023, January 28). Agency for Healthcare Research and Quality HCUP-US Methods Series, Available online: https:\/\/www.hcup-us.ahrq.gov\/reports\/methods\/methods.jsp."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.jor.2021.09.006","article-title":"Impact of Delayed Intervention on Clinical Outcomes Following Traumatic Hip Fracture in the Elderly: A National Analysis","volume":"27","author":"Tran","year":"2021","journal-title":"J. Orthop."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1016\/j.athoracsur.2021.07.059","article-title":"Impact of Chronic Lymphocytic Leukemia on Outcomes and Readmissions After Cardiac Operations","volume":"114","author":"Madrigal","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e000962","DOI":"10.1136\/tsaco-2022-000962","article-title":"Developing and Validating a Scoring System for Measuring Frailty in Patients with Hip Fracture: A Novel Model for Predicting Short-Term Postoperative Mortality","volume":"7","author":"Forssten","year":"2022","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2155","DOI":"10.1007\/s00068-023-02308-7","article-title":"Validation of the Orthopedic Frailty Score for Measuring Frailty in Hip Fracture Patients: A Cohort Study Based on the United States National Inpatient Sample","volume":"49","author":"Forssten","year":"2023","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1093\/bja\/aen236","article-title":"Development and Validation of a Preoperative Scoring System to Predict 30 Day Mortality in Patients Undergoing Hip Fracture Surgery","volume":"101","author":"Maxwell","year":"2008","journal-title":"Br. J. Anaesth."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"952","DOI":"10.1093\/bja\/aex148","article-title":"Prediction of Postoperative Mortality in Elderly Patients with Hip Fracture: Are Specific and Geriatric Scores Better than General Scores?","volume":"118","author":"Boddaert","year":"2017","journal-title":"Br. J. Anaesth."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.otsr.2019.02.004","article-title":"Validation of the Nottingham Hip Fracture Score (NHFS) to Predict 30-Day Mortality in Patients with an Intracapsular Hip Fracture","volume":"105","author":"Kuijper","year":"2019","journal-title":"Orthop. Traumatol. Surg. Res. OTSR"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2138","DOI":"10.1016\/j.injury.2016.07.022","article-title":"Prediction of Early Mortality Following Hip Fracture Surgery in Frail Elderly: The Almelo Hip Fracture Score (AHFS)","volume":"47","author":"Nijmeijer","year":"2016","journal-title":"Injury"},{"key":"ref_17","first-page":"354","article-title":"Development and Validation of the Brabant Hip Fracture Score for 30-Day and 1-Year Mortality","volume":"30","author":"Gosens","year":"2020","journal-title":"Hip Int. J. Clin. Exp. Res. Hip Pathol."},{"key":"ref_18","unstructured":"(2023, February 02). Agency for Healthcare Research and Quality Elixhauser Comorbidity Software Refined for ICD-10-CM, Available online: https:\/\/www.hcup-us.ahrq.gov\/toolssoftware\/comorbidityicd10\/comorbidity_icd10.jsp."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Subramaniam, A., Ueno, R., Tiruvoipati, R., Darvall, J., Srikanth, V., Bailey, M., Pilcher, D., and Bellomo, R. (2022). Defining ICD-10 Surrogate Variables to Estimate the Modified Frailty Index: A Delphi-Based Approach. BMC Geriatr., 22.","DOI":"10.1186\/s12877-022-03063-x"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jss.2013.01.021","article-title":"Accumulating Deficits Model of Frailty and Postoperative Mortality and Morbidity: Its Application to a National Database","volume":"183","author":"Velanovich","year":"2013","journal-title":"J. Surg. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.jamcollsurg.2017.11.005","article-title":"New 5-Factor Modified Frailty Index Using American College of Surgeons NSQIP Data","volume":"226","author":"Subramaniam","year":"2018","journal-title":"J. Am. Coll. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1002\/lary.26735","article-title":"The Effect of Frailty on Short-Term Outcomes after Head and Neck Cancer Surgery","volume":"128","author":"Nieman","year":"2018","journal-title":"Laryngoscope"},{"key":"ref_23","unstructured":"(2023, May 14). ACG System Version 11.0 Technical Reference Guide. Available online: https:\/\/www.hopkinsacg.org\/document\/acg-system-version-11-technical-reference-guide\/."},{"key":"ref_24","unstructured":"(2008). R Development Core Team R: A Language and Environment for Statistical Computing. J. Data Anal. Inf. Process., 3."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Applied Logistic Regression, John Wiley & Sons.","DOI":"10.1002\/9781118548387"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1007\/s00774-020-01187-x","article-title":"Performance of the Nottingham Hip Fracture Score and Clinical Frailty Scale as Predictors of Short and Long-Term Outcomes: A Dual-Centre 3-Year Observational Study of Hip Fracture Patients","volume":"39","author":"Thorne","year":"2021","journal-title":"J. Bone Miner. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1007\/s00223-020-00722-2","article-title":"The Ability of the Nottingham Hip Fracture Score to Predict Mobility, Length of Stay and Mortality in Hospital, and Discharge Destination in Patients Admitted with a Hip Fracture","volume":"107","author":"Lisk","year":"2020","journal-title":"Calcif. Tissue Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1097\/BOT.0000000000001140","article-title":"Discriminative Ability for Adverse Outcomes After Surgical Management of Hip Fractures: A Comparison of the Charlson Comorbidity Index, Elixhauser Comorbidity Measure, and Modified Frailty Index","volume":"32","author":"Ondeck","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Choi, J.-Y., Kim, J.-K., Kim, K., Lee, Y.-K., Koo, K.-H., and Kim, C.-H. (2021). How Does the Multidimensional Frailty Score Compare with Grip Strength for Predicting Outcomes after Hip Fracture Surgery in Older Patients? A Retrospective Cohort Study. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02150-9"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"104552","DOI":"10.1016\/j.archger.2021.104552","article-title":"Hospital Frailty Risk Score Predicts Adverse Events in Older Patients with Hip Fractures after Surgery: Analysis of a Nationwide Inpatient Database in Japan","volume":"98","author":"Shimizu","year":"2022","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1007\/s00198-021-06215-8","article-title":"The Association of Frailty with Clinical and Economic Outcomes among Hospitalized Older Adults with Hip Fracture Surgery","volume":"33","author":"Kwak","year":"2022","journal-title":"Osteoporos. Int."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.jamda.2017.07.005","article-title":"FRAIL Questionnaire Screening Tool and Short-Term Outcomes in Geriatric Fracture Patients","volume":"18","author":"Gleason","year":"2017","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/2151458515591170","article-title":"Frailty and Short-Term Outcomes in Patients with Hip Fracture","volume":"6","author":"Kistler","year":"2015","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1093\/ageing\/aft084","article-title":"Predicting Outcome after Hip Fracture: Using a Frailty Index to Integrate Comprehensive Geriatric Assessment Results","volume":"43","author":"Krishnan","year":"2014","journal-title":"Age Ageing"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.jamcollsurg.2014.03.020","article-title":"Validating Trauma-Specific Frailty Index for Geriatric Trauma Patients: A Prospective Analysis","volume":"219","author":"Joseph","year":"2014","journal-title":"J. Am. Coll. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"2919","DOI":"10.1007\/s00068-021-01612-4","article-title":"The Mortality Burden in Patients with Hip Fractures and Dementia","volume":"48","author":"Ioannidis","year":"2021","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_37","unstructured":"Mendiratta, P., Schoo, C., and Latif, R. (2023). Clinical Frailty Scale. StatPearls, StatPearls Publishing."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1111\/anae.14596","article-title":"Reliability of Frailty Assessment in the Critically Ill: A Multicentre Prospective Observational Study","volume":"74","author":"Pugh","year":"2019","journal-title":"Anaesthesia"},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Young, R.L., and Smithard, D.G. (2020). The Clinical Frailty Scale: Do Staff Agree?. Geriatrics, 5.","DOI":"10.3390\/geriatrics5020040"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"868","DOI":"10.1136\/emermed-2019-208633","article-title":"Agreement and Predictive Value of the Rockwood Clinical Frailty Scale at Emergency Department Triage","volume":"38","author":"Shrier","year":"2021","journal-title":"Emerg. Med. J. EMJ"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1093\/ageing\/afab006","article-title":"A Classification Tree to Assist with Routine Scoring of the Clinical Frailty Scale","volume":"50","author":"Theou","year":"2021","journal-title":"Age Ageing"},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Archibald, M.M., Lawless, M., Gill, T.K., and Chehade, M.J. (2020). Orthopaedic Surgeons\u2019 Perceptions of Frailty and Frailty Screening. BMC Geriatr., 20.","DOI":"10.1186\/s12877-019-1404-8"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/6\/621\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:56:16Z","timestamp":1760108176000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/14\/6\/621"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,10]]},"references-count":42,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jpm14060621"],"URL":"https:\/\/doi.org\/10.3390\/jpm14060621","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,10]]}}}