Journal of Clinical Nursing

Prediction Models for Postoperative Pneumonia in Elderly Hip Fracture Patients: A Systematic Review and Critical Appraisal

ABSTRACT

Background

Although several models have been developed to predict postoperative pneumonia in elderly hip fracture patients, no systematic review of the model quality and clinical applicability has been reported.

Objective

To systematically review and critically appraise existing models for postoperative pneumonia in elderly hip fracture patients.

Design

Systematic review and meta-analysis.

Methods

10 databases were systematically searched from inception to April 15, 2024, updated on August 26. Two reviewers independently performed literature selection, information extraction and quality assessment. A narrative synthesis was employed to summarise the characteristics of the models. Meta-analysis was performed using Stata 17.0.

Results

13 studies containing 25 models were included. The prevalence of pneumonia was 9.62% (95% CI: 7.62%–11.62%). Age (53.8%), hypoproteinemia (46.2%), chronic obstructive pulmonary disease (COPD, 30.8%), gender (30.8%), activity of daily living score (ADL, 30.8%) and American Society of Anesthesiologists (ASA, 30.8%) score were the top six predictors. All models reported area under curve (AUC: 0.617–0.996). 9 studies (69.2%) used the Hosmer-Lemeshow (H-L) test, calibration curves, or Brier scores to evaluate the calibration. 5 studies (38.5%) performed internal validation, 4 studies (30.8%) performed external validation. All studies had a high risk of bias due to single sample source, inappropriate data processing, inadequate model evaluation, and negligence of calibration and validation. 10 studies (76.9%) had good applicability.

Conclusions

Prediction models for postoperative pneumonia in elderly hip fracture patients are still in the developing stage. The validation and evaluation of existing models are poor. Future studies should focus on robust external validation and updating. Additionally, the Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis + artificial intelligence (TRIPOD+AI) statement should be followed.

Relevance to Clinical Practice

Prediction models are effective in discriminating postoperative pneumonia in elderly hip fracture patients, but further external validation and adjustment are still warranted.

PLOS ONE Medicine&Health

Arthroscopic assisted versus open core decompression for osteonecrosis of the femoral head: A systematic review and meta-analysis

by Wensi Ouyang, Guimei Guo, Jie Xia, Changwei Zhao, Xiaoling Zhou

Minimally invasive treatment options for osteonecrosis of the femoral head (ONFH) have been a prominent area of research in recent years. Arthroscopic-assisted treatments have been applied in the clinical management of ONFH; however, high-quality evidence verifying their effectiveness and safety is still lacking.

To systematically assess the clinical efficacy and safety of arthroscopic-assisted core decompression (AACD) in treating ONFH.

A comprehensive literature search was conducted in PubMed, Web of Science, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, and the Chinese BioMedical Literature Database, from inception to June 25, 2024. We identified randomized controlled trials and non-randomized controlled studies on AACD for the treatment of ONFH based on predefined inclusion and exclusion criteria. A meta-analysis was performed using Review Manager 5.4.1 and Stata 17.0 software. The analyzed outcomes included operative time, intraoperative blood loss, length of hospital stay, postoperative femoral head collapse rate, Harris hip score, and postoperative complication rate. The Grades of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to assess the quality of evidence for the outcome indicators.

A total of fourteen studies were included in this meta-analysis, comprising 1,063 patients-541 in the core decompression (CD) group and 522 in the AACD group. The meta-analysis revealed no significant differences between the two groups in terms of intraoperative blood loss, length of hospital stay, 12-month postoperative Harris hip score, or overall postoperative complication rate (P > 0.05). However, the AACD group had a longer operative time (MD = 31.19, 95% Cl: 5.32 to 57.07, P = 0.02) and a lower overall postoperative femoral head collapse rate (RR = 0.49, 95% Cl: 0.27 to 0.89, P = 0.02) compared with the CD group. Additionally, the AACD group showed significant improvements in Harris hip scores at 3 months (MD = 6.39, 95% Cl: 5.44 to 7.33, P P P P Conclusion

This meta-analysis suggests that AACD is an effective and safe treatment for patients with ONFH. However, due to the limited quantity and quality of the included studies, these results should be interpreted with caution. Further high-quality studies are recommended to confirm these findings.