Research Article
Predicting Discharge Location among Low-Energy Hip
Fracture Patients Using the Score for Trauma Triage in
the Geriatric and Middle-Aged (STTGMA)
Sanjit R. Konda , Hesham Saleh, Ariana Lott, and Kenneth A. Egol
Department of Orthopedic Surgery, NYU Langone Medical Center, 301 East 17th Street, New York, NY 10003, USA
Correspondence should be addressed to Sanjit R. Konda; sanjit.konda@nyumc.org
Received 25 May 2018; Revised 9 October 2018; Accepted 11 October 2018; Published 18 November 2018
Academic Editor: Allen L. Carl
Copyright © 2018 Sanjit R. Konda et al. Tis is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Patterns of discharge location may be evident based on the “sickness” profle of the patient. Tis study sought to evaluate the
ability of the STTGMA tool, a validated mortality risk index for middle-aged and geriatric trauma patients, to predict discharge
location in a cohort of low-energy elderly hip fracture patients, with successful discharge planning measured by readmission rates.
Low-energy hip fracture patients aged 55 years and older were prospectively followed throughout their hospitalization. On initial
evaluation in the Emergency Department, each patient’s age, comorbidities, injury severity, and functional status were utilized
to calculate a STTGMA score. Discharge location was recorded with the primary outcome measure of an unsuccessful discharge
being readmission within 30 days. Patients were risk stratifed into minimal-, low-, moderate-, and high-risk STTGMA cohorts. A
p-value of <0.05 was considered signifcant for all statistical tests. 408 low-energy hip fractures were enrolled in the study with
a mean age of 81.3±10.6 years. Tere were 214 (52.5%) intertrochanteric fractures, 167 (40.9%) femoral neck fractures, and 27
(6.6%) subtrochanteric femur fractures. Tere was no diference in readmission rates within STTGMA risk cohorts with respect to
discharge location; however, among individual discharge locations there was signifcant variation in readmission rates when patients
were risk stratifed. Overall, STTGMA risk cohorts appeared to adequately risk-stratify readmission with 3.5% of minimal-risk
patients experiencing readmission compared to 24.5% of moderate-risk patients. Specifc cohorts deemed high-risk for readmission
were adequately identifed. Te STTGMA tool allows for prediction of unfavorable discharge location in hip fracture patients. Based
on observations made via the STTGMA tool, improvements in discharge planning can be undertaken to increase home discharge
and to more closely track “high-risk” discharges to help prevent readmissions.
1. Introduction
According to national projections by the US Census Bureau,
the older population of the United States will undergo
considerable growth in the upcoming years [1]. Current
estimations report that the geriatric population, aged 65 years
and older, will increase from 43.1 million in 2012 to 83.7
million in 2050 [1]. It is estimated that they will account for
over 20% of the general population [2]. Trauma is currently
the ffh leading cause of death in older adults. In 2050, the
older population will account for approximately 40% of all
trauma cases [3].
Hip fractures are common in the middle-aged and geri-
atric trauma population. Currently, more than 250,000 hip
fractures occur each year in the United States, with that
estimate expected to increase to 840,000 by 2040 [4]. Hip
fractures are associated with signifcant morbidity, mortality,
and costs [5]. In fact, hip fractures account for 14% of all
fractures yet comprise 72% of overall fracture care costs [6].
Given the expected increase in the older population and
serious health and fnancial consequences associated with
hip fractures in this population, proper management of these
patients is imperative.
Interdisciplinary care, consisting of geriatric consul-
tations, discharge planning, and rehabilitation has been
shown to improve functional capacity and reduce mor-
tality afer hip fracture surgery [7–9]. In conjunction
with a multidisciplinary approach, having defned posta-
cute care pathways reduces costs and utilization of hospi-
tal resources [10]. Although patient care involves several
Hindawi
Advances in Orthopedics
Volume 2018, Article ID 9793435, 6 pages
https://doi.org/10.1155/2018/9793435