Analysis of intensive care unit admissions for older adults with femoral fractures: a retrospective cohort

Cobra, Carolina Rodrigues Mendes Nogueira; Garcia, Paulo Carlos; Passos, Isadora Castilho Moreira de Oliveira; Rocha, Greiciane da Silva; Nogueira, Lilia de Souza

doi:10.1590/1980-220X-REEUSP-2023-0398en

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 58 • 2024 • https://doi.org/10.1590/1980-220X-REEUSP-2023-0398en copy

Analysis of intensive care unit admissions for older adults with femoral fractures: a retrospective cohort

Análisis de los ingresos de ancianos con fracturas de fémur a unidades de cuidados intensivos: cohorte retrospectiva

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

To describe the historical series of admissions to the Intensive Care Unit of older adults with femoral fractures, and verify the association between age and injury characteristics and treatment, nursing workload, severity, and clinical evolution in the unit.

Method:

Retrospective cohort of 295 older adults (age ≥60 years) admitted to the Intensive Care Unit of a hospital in São Paulo, between 2013 and 2019, and who presented with a femur fracture as the main cause of hospitalization. Variables regarding demographic characteristics, cause, and type of fracture, treatment provided, severity, nursing workload, and medical outcome of patients were analyzed. The Shapiro-Wilk, Wilcoxon-Mann-Whitney, Kruskal-Wallis tests and Pearson correlation were applied.

Results:

There was an increase in older adults admission to the Intensive Care Unit from 2017 on. Female patients with distal femur fractures who died in the Intensive Care Unit had significantly (p < 0.05) higher median age than men, patients with shaft or proximal femur fractures, and survivors.

Conclusion:

The study findings highlight essential information for structuring care for older adults with femoral fractures who require intensive care.

DESCRIPTORS
Femoral Fractures; Aged; Intensive Care Units; Workload; Mortality

Variables	n (%)	Mean (SD)	Median (1st – 3rd quartile)
Sex
Female	213 (72.2)
Male	82 (27.8)
Age		82.3 (8.3)	83 (78 – 101)
Charlson comorbidity index		4.4 (1,1)	4 (4 – 5)
Cause of femur fracture
Fall from own height	260 (88.1)
Fall from one level to another	31 (10.5)
Others^* * Pathological fracture (n = 2), being run over (n = 1), crushing (n = 1).	4 (1.4)
Anatomical region of the fracture
Diaphysis	23 (7.8)
Distal	158 (53.6)
Proximal	114 (38.6)
Type of treatment
Surgical	284 (92.3)
Non-surgical	11 (3.7)
Risk of death according to SAPS 3		14.6 (15.9)	8.4 (4.7 – 17.1)
NAS ICU admission		67.7 (17.3)	66.1 (53.7 – 79.7)
NAS stay in the ICU		59.3 (13.1)	56.4 (50.8 – 66.3)
Length of stay in the ICU (in days)		4.7 (5.7)	2.9 (1.1 – 6.0)
Clinical outcome in the ICU
Survivor	241 (81.7)
Non-survivor	54 (18.3)

Variables	Age	p
Variables	Median (1st – 3rd quartile)	p
Sex
Female	84 (79 – 88)	0.007^* * Wilcoxon-Mann-Whitney Test;
Male	81 (74 – 86.7)	0.007^* * Wilcoxon-Mann-Whitney Test;
Cause of femur fracture
Fall from own height	83 (78 – 88)	0.176^ Kruskal-Wallis Test ICU: Intensive care unit.
Fall from one level to another	83 (76.5 – 87.5)
Other	78.5 (74.5 – 80.2)
Anatomical region of the fracture
Diaphysis	80 (76 – 85.5)	0.047^ Kruskal-Wallis Test ICU: Intensive care unit.
Distal	84 (79 – 88)
Proximal	82.5 (76.2 – 88)
Type of treatment
Surgical	83 (78 – 88)	0.616^* * Wilcoxon-Mann-Whitney Test;
Non-surgical	85 (79.5 – 88.5)	0.616^* * Wilcoxon-Mann-Whitney Test;
Clinical outcome in the ICU
Survivor	83 (77 – 87)	0.015^* * Wilcoxon-Mann-Whitney Test;
Non-survivor	85.5 (82 – 89.7)	0.015^* * Wilcoxon-Mann-Whitney Test;

Variables	r^* * Pearson Correlation Coefficient; CI: Confidence Interval; Min Minimum: Max: Maximum; NAS: Nursing Activities Score; ICU: Intensive care unit Simplified Acute Physiology Score version 3.	95%CI
Variables		Min	Max
Charlson comorbidity index	0.354	0.250	0.450
NAS ICU admission	–0.059	–0.173	0.055
NAS stay in the ICU	–0.003	–0.117	0.111
Risk of death according to SAPS 3	0.060	–0.055	0.173
Length of stay in the ICU (in days)	0.029	–0.085	0.143

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Lilia de Souza Nogueira, Avenida Doutor Enéas de Carvalho Aguiar, 419, Cerqueira César, 05403-000 – São Paulo, SP, Brazil, lilianogueira@usp.br