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. 2016 Apr 14:17:166.
doi: 10.1186/s12891-016-1018-7.

Patient and system factors of mortality after hip fracture: a scoping review

K J Sheehan  1 , B Sobolev  2 , A Chudyk  3 , T Stephens  2 , P Guy  3   4
Affiliations

Patient and system factors of mortality after hip fracture: a scoping review

K J Sheehan et al. BMC Musculoskelet Disord. .

Abstract

Background: Several patient and health system factors were associated with the risk of death among patients with hip fracture. However, without knowledge of underlying mechanisms interventions to improve survival post hip fracture can only be designed on the basis of the found statistical associations.

Methods: We used the framework developed by Arksey and O'Malley and Levac et al. for synthesis of factors and mechanisms of mortality post low energy hip fracture in adults over the age of 50 years, published in English, between September 1, 2009 and October 1, 2014 and indexed in MEDLINE. Proposed mechanisms for reported associations were extracted from the discussion sections.

Results: We synthesized the evidence from 56 articles that reported on 35 patient and 9 system factors of mortality post hip fracture. For 21 factors we found proposed biological mechanisms for their association with mortality which included complications, comorbidity, cardiorespiratory function, immune function, bone remodeling and glycemic control.

Conclusions: The majority of patient and system factors of mortality post hip fracture were reported by only one or two articles and with no proposed mechanisms for their effects on mortality. Where reported, underlying mechanisms are often based on a single article and should be confirmed with further study. Therefore, one cannot be certain whether intervening on such factors may produce expected results.

Keywords: Hip fracture; Mortality; Patient factors; Scoping review; System factors.

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Figures

Fig. 1
Fig. 1
Flow chart of the literature retrieval, review, exclusion and selection with sorting by follow up time. n = number. * = Studies excluded with patient populations less than 50 years old, pathological or high impact hip fractures, or whose main independent variables were laboratory tests or operation type
Fig. 2
Fig. 2
Examples of mechanisms proposed for patient factors in reviewed articles. Black node indicates the outcome. White nodes indicates a reported factor. Square box indicates a measurable mediator. Grey node indicates a hypothetical mediator
See this image and copyright information in PMC

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