COVID-19 and Proximal Femur Fracture in Older Adults-A Lethal Combination? An Analysis of the Registry for Geriatric Trauma (ATR-DGU).
Bastian Pass, Elvira Vajna, Tom Knauf and 6 others
PMID 34678268WHAT IT FOUND
Older patients having hip fracture surgery who tested positive for COVID-19 at admission had more in-hospital deaths (26% vs 5.9%), longer stays, lower quality of life, and were less often discharged to rehab.
Key findings
01Patients testing positive for COVID-19 had 26% in-hospital mortality versus 5.9% in patients testing negative.
02In adjusted models, the odds of dying were 5.95 higher for patients testing positive at admission.
03The median hospital stay for survivors was 19.1 days for positive-tested patients and 15.1 days for negative-tested patients.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a retrospective registry analysis, so it can show association but cannot prove that a positive test caused worse outcomes. The positive group was small: 123 patients, compared with 3610 negative patients. The hospitals were specialized geriatric trauma centers, so results may not apply to all hospitals treating hip fractures. The registry did not distinguish symptomatic from asymptomatic infection and did not record vital signs, intensive care treatment, cause of death, or patients' preferences about treatment limitations. 839 patients were excluded because COVID-19 status was missing, and many outcome measures had missing data. Positive patients were more likely to be from nursing homes and had restricted self-mobility at baseline, so groups were not perfectly comparable despite adjustment.
The easy way to misread this
Do not read these results as proof that COVID-19 infection alone caused the worse outcomes. The study was observational, did not distinguish symptomatic from asymptomatic infection, did not record vital signs, intensive care treatment, cause of death, or patients' preferences about treatment limitations, and positive patients were more likely to come from nursing homes and have restricted mobility before injury.