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Mean age was 85.6 ( ± 6.9) years, 89.2% were women. Overall

1-year mortality was 23.2%. Sensitivity to predict 1-year mortality was

53% for AChI, 86% for ASA and 91% for NHFS. Unadjusted 1-year

mortality Odds Ratio (OR) (CI 95%) were 2.16 (1.48

3.15) for AChI, 3.29


5.78) for ASA, and 4.99 (2.67

9.31) for NHFS (all with p < 0.001).

Age and sex adjusted 1-year mortality OR (CI 95%) were 1.90 (1.30

2.81) for AChI (p = 0.001), 2.90 (1.64

5.12) for ASA (p < 0.001), and

4.02 (2.10

7.81) for NHFS (p < 0.001).


The three scoring instruments analysed showed a good

accuracy for predicting 1-year mortality. The Nothinghan Hip Fracture

Score showed the best discriminative performance. (Founded with

grants from IdiPAZ and Nestle Health Science, 2013)


Comparison of key characteristic differences of younger versus

older patients admitted with major trauma

K. Nourein, D. Aw.

Nottingham University Hospitals NHS Trust


There is an increasing proportion of elderly patients

admitted with major trauma. We looked at patients admitted with

trauma to a national major trauma centre in the East Midlands, United

Kingdom. We aimed to find out key characteristic differences between

those 65 and over versus those younger.


Data was analysed retrospectively though Trauma and

Audit Research Network (TARN) and medway database for patients

admitted to Queen

s Medical Centre Nottingham from April 2014 to

March 2015.


There were 1514 patients admitted with trauma, of which

589 (38.90%) were 65 and over. The mechanisms of injury in those

65 yrs were mainly: 68.93% fall <2 metres; 14.10% fall >2 metres

and 15.62% vehicular incidents, whilst in those <65 yrs it was mostly

due to vehicular incidents (43.57%), fall <2 metres (32.97%), and fall >2

metres (11.68%). The average length of stay (LOS) was 17 days for

the older age group versus 13 days for the younger age group. The

mortality amongst the older age group was 13.24% as compared with

3.14% in the younger counterparts, Of the older patients ,152 (56%)

went back to their usual place of residence as compared to 562 (84%)

of the younger patients. Percentage distribution according to injury

severity score (ISS) was similar in both groups.


A significant proportion of patients admitted with trauma

are elderly. Although elderly are more likely to have low impact injury,

they have relatively similar ISS scores, longer LOS, higher mortality

and are less likely to be discharged home compared to their younger



A retrospective study of regional anaesthesia with continuous

peripheral nerve blocks to enhance recovery in elderly patients

following hip fracture fixation

the Singapore experience

P.W. Wong


, S.B. Loganathan


, W.H. Bin


, E. Seet


, C. Quek


, L. Chua



Y.D. Chen


, U.M. Jagadish




Department of Anaesthesia, Khoo Teck Puat

Hospital, Alexandra Health Systems,


Nursing Administration, Khoo Teck

Puat Hospital, Alexandra Health Systems,


Department of Physiotherapy,

Khoo Teck Puat Hospital, Alexandra Health Systems,


Department of

Orthopaedics, Khoo Teck Puat Hospital, Alexandra Health Systems,


Department of Geriatric Medicine, Khoo Teck Puat Hospital, Alexandra

Health Systems, Singapore


In late 2014, KTPH spearheaded the first tripartite

Hip Fracture Unit (HFU) in Singapore, where Geriatrics, Orthopaedics

and Anaesthesia, along with allied health, sought to integrate and

improve hip fracture care. Recognising that pain management is a

major cornerstone, we championed the concept of optimal analgesia

throughout the patient journey, not just perioperatively, and focused

on early ambulation. While opioids and single injection nerve blocks

have been advocated 1,2, we explored the routine use of continuous

peripheral nerve blocks (CPNB).


Retrospective analysis of 470 patients admitted under the

HFU conducted from November 2014 to January 2016.


A total of 374 patients who underwent hip fixation received

CPNB to address fracture or surgical pain. Patients with CPNB had

optimal analgesia scores, able to ambulate at mean 2.3+/

1.9 post-

operative day (POD) compared with international data of mean 5

days, with a comparable average age 79.6+/

8 years vs 80+/

7 years

2,3. Length of stay remained stable despite having increasingly

older (mean increased by 2 years) and complex patients (increase of

American Society of Anesthesiologists physical status score (ASA) 3 by

22% and ASA 4 by 7%). Patient satisfaction scores were consistently

near 100%. No CPNB related infections or unwarranted motor blockade

were found.


A paradigm shift towards a functional-targeted continu-

ous painmanagement has improved the quality of care for increasingly

complex HFU patients, and promoted early ambulation and recovery.

Our innovative use of CPNB is a safe and potentially newanalgesia gold

standard for hip fracture management.



Australian and New Zealand Guideline for Hip Fracture Care-

Improving outcomes in hip fracture care for adults

. Australian

Government: National Health and Medical Research Council: 2014.

2. Hip fracture management. NICE guidelines 2014.

3. Siu AL, Penrod JD

et al.

Early Ambulation after Hip Fracture: effects

on function and mortality.

Arch Intern Med

2006: 166(7): 766



Chest X-ray for hip fractures: are we missing anything?

M.J. Rawle


, L. Mieiro


, R. Purcell





s College London,



of Medicine for Elderly People, Whipps Cross University Hospital, Barts

Health NHS Trust, London, UK


Many feel that a pre-operative chest x-ray (CXR) in

hip fracture patients is important to optimise management and

avoid delay to surgery [1]. However, relevance of CXR for otherwise

presumed healthy individuals aged 60 and older is contentious [1][2].

The authors investigate the outcome of routine CXR for hip fracture

patients in clinical practice.


Exploratory analysis of routinely collected data in an

orthogeriatrics ward of a British University Hospital over a 5-month

period. All patients aged 60 and over admitted with hip fracture

were included. CXRs conducted at presentation were reviewed by

Radiologist and Geriatrician for pathology and then contrasted with

any repeat CXR conducted during the same admission.


130 cases retrieved, of which 127 had an initial CXR.

Pathology was identified in 28% of cases. During the same admission,

47% required repeat CXR. Comparison was drawn to the initial x-ray.

Of these, a further 22 cases showed new pathology. More than a half

showed new consolidation. Other findings included pulmonary

oedema and lung nodules. Overall, 56% of the initial CXRs conducted

were relevant in the immediate or later management. Those more

likely to have positive findings were older, frail and had dementia.

Nonetheless, pathology was evident across all age groups.


Almost a third of patients admitted with hip fracture

had a pathological CXR. Half of conducted CXRs had a direct impact on

the patients

medical management. Therefore, a routine pre-operative

CXR as a baseline for patients over 60 should be included in hip

fracture clinical pathways.


1. British Orthopaedic Association.

The care of patients with hip


. The Blue Book. September 2007.

2. Royal College of Radiologists.

Pre-op CXR for Elective Surgery

. Online

guidance, 2008.

Poster presentations / European Geriatric Medicine 7S1 (2016) S29