Frequency and impact of active clinical issues and new impairments on hospital discharge in patients with hip fracture.
Halm, E. A., Magaziner, J., Hannan, E. L., Wang, J. J., Silberzwieg, S. B., & Boochvar, K. (2003). Archives of Internal Medicine, 163(1), 107–112.
The objective of the study was to assess the frequency and impact of clinical problems at discharge on clinical and functional hip fracture outcomes. The investigators collected clinical data on 559 patients in a prospective multicenter observational cohort study. Active clinical issues (ACIs) on discharge included: (1) temperature of 38.3° C or higher, (2) heart rate of more than 100/beats per minute or fewer than 60/beats per minute, (3) systolic blood pressure higher than 180 mm Hg or lower than 90 mm Hg, (4) diastolic blood pressure higher than 110 mm Hg or lower than 60 mm Hg, (5) respiratory rate of more than 24 breaths per minute, (6) oxygen saturation of less than 90%, (7) altered mental status, (8) no oral intake, (9) shortness of breath, (10) chest pain, (11) arrhythmias, or (12) wound infection. New (i.e., after admission) impairments (NIs) included: (1) bowel and bladder incontinence, (2) inability to get out of bed, and (3) decubitus ulcer. Outcomes were: (1) death, (2) readmission, and (3) the patient’s functional mobility 60 days after discharge.
The results of the study showed that 94 patients (16.8%) had one or more ACIs, and 229 (41.0%) had one or more NIs on discharge. Both ACIs and NIs on discharge were associated with increased risk-adjusted rates of death. NIs on discharge were associated with worse functional mobility.
Clinical implications indicate that ACIs and NIs in the 24 hours before discharge are common and increase the risk of poor post-hospital outcomes. Discharging a patient to a nursing home or rehabilitation hospital by itself does not mitigate this increased hazard. Therefore, hip fracture patients with ACI and NI problems after hip surgery may benefit from more intense observation and treatment in the post-acute care settings.