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Int. J. Environ. Res. Public Health 2016, 13(10), 995; doi:10.3390/ijerph13100995

Association of Osteoporosis Self-Assessment Tool for Asians (OSTA) Score with Clinical Presentation and Expenditure in Hospitalized Trauma Patients with Femoral Fractures

1
Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
2
Chang Gung University College of Medicine, Taoyuan City 33302, Taiwan
3
Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
4
Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 83301, Taiwan
These authors contribute equally to this paper.
*
Author to whom correspondence should be addressed.
Academic Editor: Paul B. Tchounwou
Received: 12 August 2016 / Revised: 26 September 2016 / Accepted: 30 September 2016 / Published: 10 October 2016
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Abstract

Background: A cross-sectional study to investigate the association of Osteoporosis Self-Assessment Tool for Asians (OSTA) score with clinical presentation and expenditure of hospitalized adult trauma patients with femoral fractures. Methods: According to the data retrieved from the Trauma Registry System between 1 January 2009 and 31 December 2015, a total of 2086 patients aged ≥40 years and hospitalized for treatment of traumatic femoral bone fracture were categorized as high-risk patients (OSTA < −4, n = 814), medium-risk patients (−1 ≥ OSTA ≥ −4, n = 634), and low-risk patients (OSTA > −1, n = 638). Two-sided Pearson’s, chi-squared, or Fisher’s exact tests were used to compare categorical data. Unpaired Student’s t-test and Mann-Whitney U-test were used to analyze normally and non-normally distributed continuous data, respectively. Propensity-score matching in a 1:1 ratio was performed using Number Crunching Statistical Software (NCSS) software (NCSS 10; NCSS Statistical Software, Kaysville, UT, USA), with adjusted covariates including mechanism and Glasgow Coma Scale (GCS); injuries were assessed based on the Abbreviated Injury Scale (AIS), and Injury Severity Score (ISS) was used to evaluate the effect of OSTA-related grouping on a patient’s outcome. Results: High-risk and medium-risk patients were predominantly female, presented with significantly older age and higher incidences of co-morbidity, and were injured in a fall accident more frequently than low-risk patients. High-risk patients and medium-risk patients had a different pattern of femoral fracture and a significantly lower ISS. Although high-risk and medium-risk patients had significantly shorter lengths hospital of stay (LOS) and less total expenditure than low-risk patients did, similar results were not found in the selected propensity score-matched patients, implying that the difference may be attributed to the associated injury severity of the patients with femoral fracture. However, the charge of surgery is significantly lower in high-risk and medium-risk patients than in low-risk patients, regardless of the total population or the selected propensity score-matched patients. This lower charge of surgery may be attributed to a less aggressive surgery applied for older patients with high or medium risk of osteoporosis. Conclusions: This study of hospitalized trauma patients with femoral fracture according to OSTA risk classification revealed that high-risk and medium-risk patients had significantly higher odds of sustaining injury in a fall accident than low-risk patients; they also present a different pattern of femoral bone fracture as well as a significantly lower ISS, shorter hospital LOS, and less total expenditure. In addition, the significantly lower charge of surgery in high-risk and medium-risk patients than in low-risk patients may be because of the preference of orthopedists for less aggressive surgery in dealing with older patients with osteoporotic femoral bone fracture. View Full-Text
Keywords: osteoporosis; Osteoporosis Self-Assessment Tool for Asians (OSTA); trauma; femoral fracture; injury severity score (ISS); length of stay (LOS); propensity-score matching osteoporosis; Osteoporosis Self-Assessment Tool for Asians (OSTA); trauma; femoral fracture; injury severity score (ISS); length of stay (LOS); propensity-score matching
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MDPI and ACS Style

Chen, C.-C.; Rau, C.-S.; Wu, S.-C.; Kuo, P.-J.; Chen, Y.-C.; Hsieh, H.-Y.; Hsieh, C.-H. Association of Osteoporosis Self-Assessment Tool for Asians (OSTA) Score with Clinical Presentation and Expenditure in Hospitalized Trauma Patients with Femoral Fractures. Int. J. Environ. Res. Public Health 2016, 13, 995.

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