Geriatric hip fractures: do they necessitate admission to a Level 1 trauma center?
Bibliographic record
Abstract
BACKGROUND: Hip fractures result in significant mortality, morbidity, and costs. Falls are the main mechanism of injury in the geriatric population with hip fractures associated with an annual cost of $9 billion dollars in the United States. Within the next decade, it is estimated that approximately 25% of the Canadian population will be 65 years and older. The cost of trauma center care is high, raising questions about the value of treating isolated hip fractures at Level 1 (tertiary) trauma centers. OBJECTIVES: To conduct a cost-effectiveness analysis of isolated geriatric hip fractures treated in Level 1 trauma centers compared with Level II and III centers. METHODS: A retrospective cohort study was comprised of patients over 65 years of age treated for isolated hip fractures in the Province of Quebec, Canada between January 1, 1998 and December 31, 2002. Data for the study was obtained from the Quebec Trauma Registry (QTR) and 3 patient cohorts were created according to treatment at 3 Level I, 29 Level II, and 21 Level III trauma centers. The primary outcome was total treatment cost defined as hospital costs for patient care from time of arrival at the hospital to discharge. All statistical analyses were carried out with SPSS version 19.0 (SPSS Inc., Chicago, Illinois). RESULTS: We identified 11,009 cases which met our inclusion criteria. The majority of patients were female (77%). Average age was 82 (Range: 65-105; SD: 7.5). The vast majority (96.9%) of admissions were as a result of falls. There were no significant differences with respect to mean age of patients, complication rate, and mortality amongst patient admitted to Level 1, 2 and 3 Trauma Centers. Average length of stay for all patients was 15.4 days (Confidence Interval 95%: 2-55). Our study finds a 20% and 60% savings of approximately $5 and $16 million dollars when patients are admitted to Level 2 and 3 Trauma Centers when compared to Level 1 Centers. CONCLUSIONS: Level 1 trauma centers do not improve the long term functional and rehabilitation outcomes of geriatric isolated hip fracture patient when compared to Level 2 and 3 centers. Our results suggest that treatment of Isolated Hip Fractures at Level 1 Trauma Centers is not cost-effective. A separate geriatric triage criteria for isolated hip fractures could lead to improved resource utilization, cost effectiveness and acute care outcomes.KEY WORDS: Elderly, Isolated hip fractures, Cost of trauma care, Trauma center performance, Level I.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.008 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 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 source (direct Gemma or distilled Codex), 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".