Development of machine-learning algorithms for 90-day and one-year mortality prediction in the elderly with femoral neck fractures based on the HEALTH and FAITH trials

Bone & Joint Open, vol. 4, pp. 168–181

Abstract

To develop prediction models using machine-learning (ML) algorithms for 90-day and one-year mortality prediction in femoral neck fracture (FNF) patients aged 50 years or older based on the Hip fracture Evaluation with Alternatives of Total Hip arthroplasty versus Hemiarthroplasty (HEALTH) and Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trials. This study included 2,388 patients from the HEALTH and FAITH trials, with 90-day and one-year mortality proportions of 3.0% (71/2,388) and 6.4% (153/2,388), respectively. The mean age was 75.9 years (SD 10.8) and 65.9% of patients (1,574/2,388) were female. The algorithms included patient and injury characteristics. Six algorithms were developed, internally validated and evaluated across discrimination (c-statistic; discriminative ability between those with risk of mortality and those without), calibration (observed outcome compared to the predicted probability), and the Brier score (composite of discrimination and calibration). The developed algorithms distinguished between patients at high and low risk for 90-day and one-year mortality. The penalized logistic regression algorithm had the best performance metrics for both 90-day (c-statistic 0.80, calibration slope 0.95, calibration intercept -0.06, and Brier score 0.039) and one-year (c-statistic 0.76, calibration slope 0.86, calibration intercept -0.20, and Brier score 0.074) mortality prediction in the hold-out set. Using high-quality data, the ML-based prediction models accurately predicted 90-day and one-year mortality in patients aged 50 years or older with a FNF. The final models must be externally validated to assess generalizability to other populations, and prospectively evaluated in the process of shared decision-making.

Authors 13

1. Hidde Dijkstra

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Geriatric Medicine, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands

   Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

   Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

2. Jacobien H. F. Oosterhoff

   Harvard University · Massachusetts General Hospital · Amsterdam University Medical Centers · Amsterdam Movement Sciences · University of Amsterdam · Delft University of Technology

   Affiliation as printed

   Department of Engineering Systems and Services, Faculty Technology Policy Management, Delft University of Technology, Delt, Netherlands

   Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

   Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

3. Anouk van de Kuit

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

   Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

4. Frank F. A. IJpma

   University Medical Center Groningen · University of Groningen

   Affiliation as printed

   Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands

5. Joseph Hasbrouck Schwab

   Harvard University · Massachusetts General Hospital

   Affiliation as printed

   Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA

6. Rudolf Wilhelm Poolman Aachen Department of Surgery, Trauma Surgery

   Leiden University Medical Center · OLVG

   Affiliation as printed

   Department of Orthopaedic Surgery, Onze Lieve Vrouw Gasthuis, Amsterdam, The Netherlands

   Department of Surgery, Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands

7. Sheila Sprague

   McMaster University

   Affiliation as printed

   Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada

   Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada

8. Sofia Bzovsky

   McMaster University

   Affiliation as printed

   Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada

9. Mohit Bhandari

   McMaster University

   Affiliation as printed

   Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada

   Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Canada

10. Marc F. Swiontkowski

    University of Minnesota

    Affiliation as printed

    Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA

11. Emil H. Schemitsch

    Western University

    Affiliation as printed

    Department of Surgery, Western University, London, Canada

12. Job Nicolaas Doornberg

    University Medical Center Groningen · University of Groningen

    Affiliation as printed

    Department of Orthopaedic Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands

13. Laurent A. M. Hendrickx

    Amsterdam University Medical Centers · Amsterdam Movement Sciences · University of Amsterdam

    Affiliation as printed

    Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands