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The Elders Risk Assessment Index, an Electronic Administrative Database–Derived Frailty Index, Can Identify Risk of Hip Fracture in a Cohort of Community-Dwelling Adults

      Abstract

      Objective

      To determine whether an Elders Risk Assessment (ERA) index can predict incident hip fractures without the need for physician-patient encounter or bone mineral density testing.

      Patients and Methods

      A retrospective cohort study was conducted in a community-based cohort of 12,650 patients aged 60 years and older. An ERA score was computed for each subject at index time (January 1, 2005). Incidents of hip fracture from January 1, 2005, through December 31, 2006, were obtained from electronic medical records. We divided the cohort into 5 groups, with the lowest ERA scores forming group A (<15%); 15% to 49%, group B; 50% to 74%, group C; 75% to 89%, group D; and the top 11%, group E. With group A as a reference group, we used logistic regression to compute odds ratios of sustaining hip fracture during a 2-year period (January 1, 2005, through December 31, 2006) for groups B, C, D, and E. Sensitivity and specificity of each possible ERA score were calculated, and a receiver operating characteristic curve was created.

      Results

      Two hundred sixty-five patients (2.1%) sustained at least 1 hip fracture from January 1, 2005, through December 31, 2006. Odds ratios (95% confidence intervals) for groups B, C, D, and E were 1.6 (0.7-3.4), 4.5 (2.2-9.4), 6.9 (3.3-14.3), and 18.4 (8.9-37.9), respectively. The area under the receiver operating characteristic curve was 74.5%.

      Conclusion

      An electronic medical record–based, easily derived ERA index might be useful in hip fracture risk stratification.

      Abbreviations and Acronyms:

      CI (confidence interval), EMR (electronic medical record), ERA (Elders Risk Assessment), FNBMD (femoral neck bone mineral density), FRAMO (Fracture and Mortality), FRAX (fracture risk assessment), GDMS (Generic Disease Management System), ICD-9 (International Classification of Diseases, Ninth Revision), OR (odds ratio), PCIM (Primary Care Internal Medicine), ROC (receiver operating characteristic)
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