@article{ref1,
title="Seasonality affects elderly hip fracture mortality risk during the COVID-19 pandemic",
journal="Curēus",
year="2022",
author="Esper, Garrett W. and Meltzer-Bruhn, Ariana T. and Ganta, Abhishek and Egol, Kenneth A. and Konda, Sanjit R.",
volume="14",
number="7",
pages="e26530-e26530",
abstract="Background The incidence of geriatric hip fractures, respiratory infections (e.g., coronavirus disease 2019 (COVID-19), influenza), and mortality is higher during the fall and winter. The purpose of this study is to assess whether the addition of seasonality to a validated geriatric inpatient mortality risk tool will improve the predictive capacity and risk stratification for geriatric hip fracture patients. We hypothesize that seasonality will improve the predictive capacity. <br><br>METHODology Between October 2014 and August 2021, 2,421 patients >55-year-old treated for hip fracture were analyzed for demographics, date of presentation, COVID-19 status (for patients after February 2020), and mortality. Patients were grouped by season based on their admission dates into the following four cohorts: fall (September-November), winter (December-February), spring (March-May), and summer (June-August). Patients presenting during the fall/winter and spring/summer were compared. The baseline Score for Trauma Triage in the Geriatric and Middle-Aged (STTGMA) tool for hip fractures (STTGMAHIP_FX_SCORE) and the seasonality iteration (STTGMA_SEASON) were also compared. Sub-analysis was conducted on 687 patients between February 2020 and August 2021 amid the COVID-19 pandemic. The baseline score (STTGMAHIP_FX_SCORE) and the COVID-19 iteration (STTGMACOVID_ORIGINAL_2020) were modified to include seasonality (STTGMA_COVID/SEASON). Patients were stratified by risk score and compared. The predictive ability of the models was compared using DeLong's test. <br><br>RESULTS For the overall cohort, patients who presented during the fall/winter had a higher rate of inpatient mortality (2.87% vs. 1.25%, p < 0.01). STTGMA_SEASON improved the predictive capacity for inpatient mortality compared to STTGMAHIP_FX_SCORE but not significantly (0.773 vs. 0.672, p = 0.105) On sub-analysis, regression weighting showed a coefficient of 0.643, with fall and winter having a greater absolute effect size (fall = 2.572, winter = 1.929, spring = 1.286, summer = 0.643). STTGMA_COVID/SEASON improved the predictive capacity for inpatient mortality compared to STTGMAHIP_FX_SCORE (0.882 vs. 0.581, p < 0.01) and STTGMACOVID_ORIGINAL_2020 (0.882 vs. 0.805, p = 0.04). The highest risk quartile contained 89.5% of patients who expired during their index inpatient hospitalization (p < 0.01) and 68.2% of patients who died within 30 days of discharge (p < 0.01). <br><br>CONCLUSIONS Seasonality may play a role in both the incidence and impact of COVID-19 and additional respiratory infections. Including seasonality improves the predictive capacity and risk stratification of the STTGMA tool during the COVID-19 pandemic. This allows for effective triage and closer surveillance of high-risk geriatric hip fracture patients by better accounting for the increased respiratory infection incidence and the associated mortality risk seen during fall and winter.<p /> <p>Language: en</p>",
language="en",
issn="2168-8184",
doi="10.7759/cureus.26530",
url="http://dx.doi.org/10.7759/cureus.26530"
}