Predicting Discharge Location among Low-Energy HipFracture Patients Using the Score for Trauma Triage inthe Geriatric and Middle-Aged (STTGMA

Patterns of discharge location may be evident based on the “sickness” profile of the patient. This study sought to evaluate theability of the STTGMA tool, a validated mortality risk index for middle-aged and geriatric trauma patients, to predict dischargelocation 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 initialevaluation in the Emergency Department, each patient’s age, comorbidities, injury severity, and functional status were utilizedto calculate a STTGMA score. Discharge location was recorded with the primary outcome measure of an unsuccessful dischargebeing readmission within 30 days. Patients were risk stratified into minimal-, low-, moderate-, and high-risk STTGMA cohorts. Ap-value of<0.05 was considered significant for all statistical tests. 408 low-energy hip fractures were enrolled in the study withameanageof81.3±10.6 years. There were 214 (52.5%) intertrochanteric fractures, 167 (40.9%) femoral neck fractures, and 27(6.6%) subtrochanteric femur fractures. There was no difference in readmission rates within STTGMA risk cohorts with respect todischarge location; however, among individual discharge locations there was significant variation inreadmission rates whenpatientswere risk stratified. Overall, STTGMA risk cohorts appeared to adequately risk-stratify readmission with 3.5% of minimal-riskpatients experiencingreadmission compared to 24.5% of moderate-riskpatients. Specific cohorts deemed high-risk for readmissionwere adequately identified. The STTGMA tool allows for prediction of unfavorable discharge location in hip fracturepatients. Basedon observations made via the STTGMA tool, improvements in discharge planning can be undertaken to increase home dischargeand to more closely track “high-risk” discharges to help prevent readmissions