Prediction Models for Postoperative Pneumonia in Elderly Hip Fracture Patients: A Systematic Review and Critical Appraisal
Abstract
BACKGROUND
Although several models have been developed to predict postoperative pneumonia in elderly hip fracture patients, no systematic review of the model quality and clinical applicability has been reported.
OBJECTIVE
To systematically review and critically appraise existing models for postoperative pneumonia in elderly hip fracture patients.
DESIGN
Systematic review and meta-analysis.
METHODS
10 databases were systematically searched from inception to April 15, 2024, updated on August 26. Two reviewers independently performed literature selection, information extraction and quality assessment. A narrative synthesis was employed to summarise the characteristics of the models. Meta-analysis was performed using Stata 17.0.
RESULTS
13 studies containing 25 models were included. The prevalence of pneumonia was 9.62% (95% CI: 7.62%-11.62%). Age (53.8%), hypoproteinemia (46.2%), chronic obstructive pulmonary disease (COPD, 30.8%), gender (30.8%), activity of daily living score (ADL, 30.8%) and American Society of Anesthesiologists (ASA, 30.8%) score were the top six predictors. All models reported area under curve (AUC: 0.617-0.996). 9 studies (69.2%) used the Hosmer-Lemeshow (H-L) test, calibration curves, or Brier scores to evaluate the calibration. 5 studies (38.5%) performed internal validation, 4 studies (30.8%) performed external validation. All studies had a high risk of bias due to single sample source, inappropriate data processing, inadequate model evaluation, and…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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