External Validation of a Prognostic Model for One-Year Survival After Fragility Hip Fracture: A Retrospective Cohort Study

Authors

  • Hairui Fu* Department of Orthopaedics, Fenyang Hospital Affiliated with Shanxi Medical University, Fenyang Hospital of Shanxi Province, No. 186 Shengli Street, Fenyang City, Lvliang City, Shanxi Province, China
  • Feixiong Li Department of Orthopaedics, Fenyang Hospital Affiliated with Shanxi Medical University, Fenyang Hospital of Shanxi Province, No. 186 Shengli Street, Fenyang City, Lvliang City, Shanxi Province, China
  • Bin Liang Department of Orthopaedics, Fenyang Hospital Affiliated with Shanxi Medical University, Fenyang Hospital of Shanxi Province, No. 186 Shengli Street, Fenyang City, Lvliang City, Shanxi Province, China
  • Dou Wu Department of Orthopaedics, The Third Hospital of Shanxi Medical University (Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital), No. 99, Longcheng Street, Taiyuan City, Shanxi Province, China
  • Xuan Zhang Central Office, Shanxi Provincial Centre for Disease Control and Prevention, No. 8 Xiaonanguan, Shuangta West Street, Taiyuan City, Shanxi Province, China

Keywords:

External validation, Prognostic model, Fragility hip fracture, Survival

Abstract

Purpose: To validate a prognostic model of mortality among patients with fragility hip fractures.

Methods: This was a retrospective cohort study. Patients with fragility hip fractures were consecutively admitted to the orthopaedics department from January 2016 to October 31, 2021. We evaluated the performance of a survival after fragility hip fracture (SFHF) model (including the full model and the simplified model) in the following ways: (1) Discrimination. We present the concordance (c) index of the model, including Harrell's c-index and Uno's c-value. Overall performance was measured with Nagelkerke R2 values. (2) Calibration. The calibration plot method was used to evaluate the calibration of the model. (3) Clinical value. Decision curve analysis (DCA) was used to determine whether the model had clinical value in the validation population.

Results: A total of 877 (out of 1132) eligible patients with fragility hip fractures (≥50 years) were included in this study. Among these patients, 47 patients were lost to follow-up. Among the patients who were successfully followed up, 87 died within 1 year after fracture. After simple imputation was applied to address missing values, the final effective sample size was 93 patients. The 1-year mortality rate after fracture was 10.6%. The Harrell’s c-index values of the full and simple SFHF models were 0.764 (standard error, 0.024) and 0.763 (0.024), respectively. Uno’s c-values were 0.765 (0.024) and 0.763 (0.024), respectively. The Nagelkerke R2 values were 0.144 and 0.144, respectively. The calibration plot revealed good calibration between the predicted and actual values of the model. DCA revealed that the model was clinically useful within a risk of death threshold range of 0.03-0.38.

Conclusion: Our study preliminarily confirmed that the SFHF model has good accuracy and generalizability in predicting the one-year survival rate of patients with fragility hip fractures and that it has good clinical value. This predictive model may be considered for use in clinical practice.

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Published

2024-12-30

Issue

Vol. 94 No. 6 (2024): Volume 94, Issue 6

Section

Original Articles

How to Cite

Hairui Fu*, Feixiong Li, Bin Liang, Dou Wu, and Xuan Zhang , trans. 2024. “External Validation of a Prognostic Model for One-Year Survival After Fragility Hip Fracture: A Retrospective Cohort Study”. Human Biology 94 (6): 899-913. https://www.humbiol.org/Home/article/view/214.

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