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Frequency and Impact of Active Clinical Issues and New Impairments on Hospital Discharge in Patients With Hip Fracture
Ethan A. Halm, MD, MPH;
Jay Magaziner, PhD;
Edward L. Hannan, PhD;
Jason J. Wang, PhD;
Stacey B. Silberzweig, MS, RD;
Kenneth Boockvar, MD, MS;
Gretchen M. Orosz, MD;
Mary Ann McLaughlin, MD, MPH;
Kenneth J. Koval, MD;
Albert L. Siu, MD, MSPH
Arch Intern Med. 2003;163:107-112.
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.
From the Departments of Health Policy (Drs Halm, Wang, McLaughlin, and Siu), Medicine (Drs Halm, Orosz, McLaughlin, and Siu), and Geriatrics and Adult Development (Ms Silberzweig and Drs Boockvar, Orosz, McLaughlin, and Siu), Mount Sinai School of Medicine, New York, NY; Department of Epidemiology and Preventive Medicine, School of Medicine, University of Maryland, Baltimore (Dr Magaziner); Department of Health Policy, Management, and Behavior, University at Albany School of Public Health, Rensselaer, NY (Dr Hannan); and Department of Orthopedics, Hospital for Joint Diseases, New York (Dr Koval).
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