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transcript
Deaths from Fracture Neck of Femur
Age standardised Death rate Fracture of Femur
age 65-84 2003-2005
0
2
4
6
8
10
12
14
16
YORKS & H
UMBER
SOUTH WEST
SOUTH EAST
EAST OF E
NGLAND
LONDON
NORTH E
AST
NORTH W
EST
EAST MID
LANDS
WEST M
IDLANDS
De
ath
ra
te p
er
10
0,0
00 Men
Women
Age standardised Death rate Fracture of Femur
age 85+ 2003-2005
0
50
100
150
200
250
300
YORKS & H
UMBER
LONDON
SOUTH EAST
SOUTH WEST
EAST OF E
NGLAND
NORTH W
EST
NORTH E
AST
EAST MID
LANDS
WEST M
IDLANDS
De
ath
ra
te p
er
10
0,0
00
MenWomen
Age specific Death rate Fracture of Femur
England & Wales 2003-2005
0
50
100
150
200
250
300
350
50-54 60-64 70-74 80-84 90+
Rat
e p
er 1
00,0
00
Men
Women
Age standardised
Death rate Fracture of FemurAge 65+ England & Wales
0
50
100
150
200
250
300
1991 1993 1995 1997 1999 2001 2003 2005
Ag
e st
and
ard
ised
rat
e p
er 1
00,0
00
Men
Women
ICD codes Deaths Fracture FemurEngland & Wales 2005
S72.0 Neck 2568
S72.1 Pertrochanteric 37
S72.2 Subtrochanteric 7
S72.3 Shaft 19
S72.4 Lower 37
S72.7 Multiple 4
S72.9 Unspecified 292
S72 Total Femur 2964
Possible reasons for high death rate
• High incidence
• High fatality rate– Inferior care– Some other reason
• Diagnostic or coding artefact
Age standardised
Admission rate Fracture Neck of FemurAge 65+ 2004/05
0
200
400
600
800
1000
SOUTH W
EST
WEST M
IDLANDS
NORTH E
AST
EAST OF E
NGLAND
EAST MID
LANDS
SOUTH E
AST
NORTH W
EST
YORKS & H
UMBER
LONDON
Ag
e S
tan
dar
dis
ed r
ate
per
100
,000
Men
Women
Hospital Admission rate
Fracture neck of FemurEngland 2005/06
0
500
1000
1500
2000
2500
3000
3500
50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Men
Women
Trends in Hospital admissions for Fracture Neck of Femur
England & Wales 1959-1977Source Lewis AF BMJ 1981; 283, 1217-1220
0
5
10
15
20
25
30
35
40
45
1955 1960 1965 1970 1975 1980
# A
dm
issi
on
s (t
ho
usa
nd
s)
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
All
Ad
mis
sio
ns
(th
ou
san
ds)
FNOF Other Fem # All Admissions
Age standardised Admission rate Fracture Neck of Femur
Age 65+
0
100
200
300
400
500
600
700
800
2000-01 2001-02 2002-03 2003-04 2004-05
Sta
nd
ard
ised
rat
e p
er 1
00,0
00
Females
England
West Midlands
Males
England
West Midlands
Indirectly age standardised Death rate within 30 days of admission for Fracture Neck of Femur 2003-2004
0
2500
5000
7500
10000
12500
EAST MID
LANDS
LONDON
SOUTH W
EST
NORTH E
AST
SOUTH E
AST
YORKS & H
UMBER
EAST OF E
NGLAND
WEST M
IDLANDS
NORTH W
EST
Ag
e S
tan
dar
dis
ed R
ate
per
100
,000
Indirectly age standardised
Percent returning to usual residence after Fracture Neck of Femur 2003/04
0
10
20
30
40
50
60
WEST M
IDLANDS
NORTH WEST
SOUTH WEST
SOUTH EAST
LONDON
NORTH EAST
EAST MID
LANDS
EAST OF E
NGLAND
YORKS & H
UMBER
Sta
nd
ard
ised
per
cen
t
Indirectly age standardised % Operated on within 48 hrs of admission
for Fracture Neck of Femur 2003/04
0
10
20
30
40
50
NORTH W
EST
EAST MID
LANDS
SOUTH W
EST
NORTH E
AST
SOUTH E
AST
YORKS & H
UMBER
LONDON
WEST M
IDLANDS
EAST OF E
NGLAND
Sta
nd
ard
ised
Per
cen
t
Classification of hip
fractures
Operative management of Fracture Neck of Femur 2005/06
0%
20%
40%
60%
80%
100%
NORTH EAST
NORTH WEST
YORKS & H
UMBER
EAST MID
LANDS
WEST M
IDLANDS
EAST OF E
NGLAND
LONDON
SOUTH EAST
SOUTH WEST
No operation
Prostheticreplacement
Primary reductionW19-W20-W21
Closed reductionW24, W25, W26
Ratio of Death and Admission rates age specific
Fractured Neck of Femur England 2004/05
0
500
1000
1500
2000
2500
45-49 55-59 65-69 75-79 85+
Rat
e p
er 1
00,0
00
0
0.05
0.1
0.15
0.2
0.25
Dea
th A
dm
issi
on
Rat
io
Deaths
Admissions
Ratio
Fatality rate after Admission for Fracture Neck of Femur
Record linkage studySource Goldacre MJ, Roberts SE, Yeates BMJ 2002; 325, 868-869
All Deaths Mention of FNOF
Within 30 days 10.5% 4.5%
Within 90 days 18.8% 6.9%
Within 180 days 24.6% 7.7%
nchod Data specification Fracture Neck of Femur
“ Cause data for fractures should be used with great care because of the effects of artefactual local differences resulting from variations in certification procedures between coroners. Deaths caused by fracture neck of femur are also under recorded because there are a number of alternatives for classifying such deaths. For these reasons, variations between areas should be interpreted with caution”