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Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits? Results of a large international prospective multicentre study
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  • Published on:
    Author's answer to letter from Tomoyuki Kawada
    • Alexander Joeris, Head of Clinical Science AO Foundation, AO Innovation Translation Center (AO ITC)

    Dear Prof. Kawada,
    Thank you for pointing out the results reported by Prestmo et al., who had randomized home-dwelling patients with hip-fractures aged 70 years or older and who were able to walk 10 m before their fracture, to either comprehensive geriatric care or orthopaedic care in the emergency department [1]. They evaluated mobility with the Short Physical Performance Battery (SPPB) and found a significantly better outcome in patients allocated to geriatric care 4 months after the intervention. This result is very well in line with our findings of improved mobility in Geriatric Fracture Center (GFC) patients, which we measured with the Timed Up and Go (TUG) test and the Parker Mobility Score (PMS), as shown in Figure 2 and eTable 6 of our publication.
    You also pointed out the study of Marcantonio et al., who reported lower rates of delirium in patients receiving geriatric care [2]. In this randomized monocentre study, one of the study groups received regular and standardized care through a geriatrician, while the other group was treated as per usual care. Patients in both groups underwent daily interviews and delirium was assessed using the CAM diagnostic algorithm. We would like to point out that this methodology is fundamentally different from ours. The standardized daily interviews in the quoted study were aimed at making it impossible to miss any episode of delirium, which allowed them to study the pure effect of the geriatrician's care on the dev...

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    Conflict of Interest:
    None declared.
  • Published on:
    RE: Geriatric fracture centre vs usual care after proximal femur fracture in older patients: what are the benefits?

    Blauth et al. conducted one-year follow-up study with participation of international multicentre (1). The authors determined the effect of treatment in geriatric fracture centres (GFC) on the incidence of major adverse events (MAEs) in patients with hip fractures by setting usual care centres (UCC) as a control. A total of 281 patients, aged ≥70 with operatively treated proximal femur fractures, were analyzed. Odds ratio (OR) (95% confidence interval [CI]) of patients in GFC against UCC for an MAE was 4.56 (2.23 to 9.34). In addition, OR (95% CI) of patients in GFC against UCC for pneumonia and delirium were 3.40 (1.08 to 10.70) and 5.76 (1.64 to 20.23), respectively. The authors explained the increased OR as higher ability of detecting MAEs in GFC than that in UCC, and considered as positive effect of geriatric comanagement. I have comments about their study.

    Blauth et al. cited 4 randomized controlled trials in the past, and most recent article was reported by Prestmo et al (2). They compared the effectiveness of treatment for hip fracture between GFC and UCC. Patients, aged ≥70, were able to walk 10 m before their fracture. Mean Short Physical Performance Battery scores at 4 months were significantly higher in GFC patients than that in UCC patients, and they recognized the advantage of GFC for the treatment of older patients with hip fractures.

    Regarding delirium as a MAE in patients after hip-fracture repair, Marcantonio et al. reported that relative risk...

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    Conflict of Interest:
    None declared.