Epidemiology, patient outcome and complications after non‐operative management of hip fracture: a systematic review
Bibliographic record
Abstract
INTRODUCTION: Surgery is the preferred treatment for hip fracture in older people. However, a proportion of patients with hip fracture do not receive surgery. There is a lack of contemporary evidence describing this patient population and what their associated outcomes are. We aimed to describe the variation in non-operative management and its outcomes around the world. METHODS: We performed a systematic review and meta-analysis of older people presenting to hospital with hip fracture, comparing those with and without surgery for non-operative proportions, mortality and other outcomes. Risk of bias was assessed using the Newcastle-Ottawa Scale. We performed a random effects meta-analysis with adjustment for clustering. RESULTS: Of 4437 screened studies, 185 were included from 172 separate cohorts, 44 countries, six continents and involving 10,763,994 patients. The overall proportion of non-operative management was 8.4% (95%CI 7.2-9.7%) with wide within-country and regional variation. There was no consistent association of non-operative management proportions with the admission characteristics of sex, fracture type or patient ethnicity. Non-operative management was associated with a greater relative risk of death at all time points. Risk of bias was generally low except for the expected confounding by indication. DISCUSSION: Non-operative management of hip fracture is relatively common, but there is wide variation that is unexplained by differences in patient characteristics. The evidence is limited by incomplete reporting of patient characteristics and outcomes, and a lack of controlled studies even in the highest risk populations. Further work is needed to understand this decision-making process.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.005 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".