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Injury. 2012 Dec;43(12):1978-84. doi: 10.1016/j.injury.2012.08.061. Epub 2012 Sep 19.

Bias towards dementia: are hip fracture trials excluding too many patients? A systematic review.

Collaborators (604)

Bhandari M, Devereaux PJ, Guyatt G, Heetveld MJ, Jeray K, Liew S, Richardson MJ, Schemitsch EH, Swiontkowski M, Tornetta P 3rd, Walter S, Mohit B, Sprague S, Viveiros H, Simunovic N, Swinton M, Heels-Ansdell D, Buckingham L, Duraikannan A, Swiontkowski MF, Agel J, van Lieshout EM, Zielinski SM, Goslings JC, Haverlag R, Ponsen MJ, de Rijcke PA, Koppert CL, Buijk SE, Groenendijk RP, Dawson I, de Rycke PA, Tetteroo GW, Bruijninckx MM, Doornebosch P, deGraaf EJ, Patka P, Eversdijk M, Peters R, van Waes O, den Hartog D, van Waes O, Oprel P, Gasthuis K, Heetveld MJ, Visser GA, Stockmann H, Silvis R, Snellen JP, Rybroek A, Scheepers JJ, Vermeulen EG, Siroen MP, Vuylsteke R, Brom HL, Ryna H, van Laarhoven HA, Haag D, Rhemrev S, Bosman CH, van Otterloo AM, Hoogendoorn J, Idenburg F, de Vries AC, Meylaerts SA, Roukema GR, Josaputra H, Keller P, de Rooij PP, Kuiken H, Boxma H, Cleffken BI, Liem R, Poolman RW, Simons MP, van der Heijden FH, Willems WJ, de Meulemeester FR, van der Hart C, Tarkan K, Festen S, de Nies F, Haverlag R, Out NJ, Bosma J, de Graaf Gasthuis R, van der Elst M, van der Pol CC, van't Reit M, van der Elst M, Karsten TM, de Vries MR, Stassen PS, Schep N, Schmidt B, Hoffman WH, Segers JM, Zijl J, Verhoeven B, Smits A, Theunissen EB, Wille J, Govaert L, Wittich P, Brauw M, Wille J, Ritchie ED, Wittish H, Wessel RN, Hammacher ER, Ziekenhuis E, Verhofstad MH, Meijer JM, van Egmond T, van den Heijden FH, Campo M, Verhagen R, van Kampen A, Biert J, van Vugt AB, Edwards M, Blokhuis T, Frolke JP, Geeraidts L, de Waal Malefyt MC, Schreurs B, Simmermacher RK, van Mulken J, van Gaalen SM, Bronovo Z, Bronkhorst MW, Guicherit OR, Frihagen F, Nordsletten L, Kibsgaard T, Haug KJ, Lona T, Ugland S, Nilsen K, Brekke AC, Vesterhus EB, Tetsworth K, Weinrauch P, Pincus P, Donald G, yang S, Halliday B, Gervais T, Holt M, Flynn A, Pirpiris M, Love D, Bucknill A, Farrugia RJ, Liew S, Dowrick A, Donohue C, Bedi H, Li D, Edwards E, Csonguray S, Miller R, Wang O, Chia A, Miller R, Jain A, Mammen M, Moaveni A, Murdock Z, Sage C, Bahadur T, Jain AK, Pankaj A, Pesantez R, Martinez A, Novoa C, Buckley RE, Duffy P, Korley R, Johnston K, Puloski S, Carcary K, Avram V, Bicknell R, Yach J, Bardana D, Wood G, Lambert S, Sanders DW, Howard J, Macleod M, Lawendy A, Bartley D, Laney T, Tieszer C, Peterson D, Zalzal P, Naumetz V, Brien H, Weening B, Wai EK, Papp S, Roffey D, McCormack R, Stone T, Perey B, Viskontas D, Boyer D, Perey B, Moola F, Zomar M, Moon K, Schemitsch EH, McKee M, Hall J, Ahn H, Vicente MR, Wild LM, Kreder HJ, Stephen DJ, Nousianinen M, Kunz M, Syed K, Azad T, Coles C, Leighton R, Johnstone D, Glazebrook M, Alexander D, Coady C, Trask K, Dobbin G, Oliver TM, Jones V, Ronan J, Tornetta P 3rd, Brown DT, Carlilse H, Shaughnessy L, Schwappach J, Davis C, Weingarten P, Weinerman S, Newman H, Baker J, Browner K, Hurley M, baker J, Payton K, Zura R, Manson MJ, Jeray K, Goetz D, Broderick SJ, Porter S, Pace T, Tanner SL, Snider B, Schmidt AH, Haas J, Templeman D, Westberg JR, Mullis B, Ertl JP, Shively K, Frizzel V, Moore MM, Marcantonio AJ, Iorio R, Lobo M, Kain M, Specht L, Tilzey J, Garfi J, Prayson MJ, Laughlin R, Rubino J, Lawless M, DiPaola M, Gayton C, Dulaney-Cripe L, Vallier HA, Wilber J, Wilber RG, Sontich JH, Patterson B, Dolenc A, Robinson C, DePaolo CJ, Alosky R, Shell E, Keeve JP, Anderson C, McDonald M, Hoffman J, Baele J, Weber T, Edison M, Musapatika D, Jones C, Ringler J, Endres T, Gelbke M, Jabara M, Sietsema DL, Engerman SM, Switzer JA, Li M, Marston S, Cole P, Vang SX, Ly T, Anderson S, Foley A, McBeth J, Comstock C, Ziran N, Shaer J, Hileman B, Karges D, Cannada L, Kuldjanov D, Watson JT, Mills JJ, Hill L, Simon T, Abdelgawad A, Shunia J, Jenkins M, Zumwalt M, Romero AW, Lowe J, Goldstein J, Zamorano DP, Lawson D, Archdeacon M, Wyrick J, Hampton S, Lewis CG, Ademi A, Sullivan R, Caminiti S, Graves M, Smith L, Della Rocca GJ, Crist BD, Murtha Y, Anderson LK, Kliewer TK, McPherson MK, Sullivan KM, Jarrett SL, Sagebien C, Seuffert P, Mehta S, Esterhai J, Ahn J, Tjoumakaris F, Horan AD, Kaminski C, Tarkin I, Siska P, Luther A, Irrgang J, Farrell DJ, Gorczyca JT, Gross JM, Kates SL, Colosi J, Hibsch N, Noble K, Neu S, Agarwal A, Wright R, Hsu JR, Randall GM, Ficke JR, Charlton M, Fan M, Garcia SH, Obremskey WT, Richards JE, Robinson K, Carroll E, Kulp B, Bhandari M, Guyatt GH, Devereaux PJ, Walter S, Schemitsch EH, Einhorn TA, Koval KJ, Poolman RW, Heetveld MJ, Tetsworth KD, Bhandari M, Sprague S, Simunovic N, Viveiros H, Culgin S, Swinton M, Heels-Ansdell D, Buckingham L, Duraikannan A, Einhorn TA, Desjardin H, van Lieshout EM, Beimers L, de Vries J, Zurcher AW, Albers GH, Rademakers M, Breugem S, van der Haven I, Damen PJ, Bulstra GH, Campo MM, Somford MP, Haverkamp D, Gasthuis OL, Poolman RW, Molekamp WJ, de Meulemeester FR, Kleipool EB, Simons MP, Haag D, Keizer SB, Swen JW, Nelissen EM, Hollander PH, Metsaars W, Thomassen JW, Fontijne WP, Wiersma SC, Boetes B, JT E, Ziekenhuis S, Nolte PA, de Jong T, van Noort A, Vergroesen DA, Van den Bekerom MP, Schutte BG, Schuman L, Hillen RJ, Cheung J, van der Heide HJ, Nagels J, Krips R, Mullers JB, Schüller H, Ziekenhuis A, van den Hout JA, Joosten AJ, van der Broek CM, Bolder SB, Eygendaal D, Moonen AF, van Geenen RC, Hoebink EA, Wagenmakers R, van Helden W, van Putten Ziekenhuis R, Kooijman R, Postema RR, Lampe HI, Ziekenhuizen G, Bolhuis HW, Bullens PH, Hogervorst M, de Kroon KE, Jansen RH, Raven EE, Ziekenhuis D, van Jonbergen HP, Reuver JM, Barnaart AF, Roerdink WH, van Erve RH, Koorevaar R, Frima AH, Flikweert ER, Falke ML, Kurek FJ, Slingerland AC, Vallei G, van Dijk JP, van Helden WH, Frihagen F, Nordsletten L, Mauer-Hansen E, Boee B, Clarke-Jensen J, Haug KJ, Nilsen K, Brekke AC, Vestergaard EB, Liew S, Dowrick A, Edwards E, Moaveni A, Carr A, Wang O, Russ M, Li D, Doig S, Chia A, Murdock Z, Buckley RE, Duffy P, Korley R, Carcary K, Laflamme Y, Fernandes JC, Poirier MF, Schemitsch EH, Bogoch E, Hall J, Ahn H, Vicente MR, Kreder H, Axelrod T, Jenkinson R, Wadey V, Nousiainen M, Stephen D, Kunz M, Macnevin M, Coles C, Leighton R, Richardson GC, Biddulph M, Gross M, Dunbar M, Trask K, Dobbin G, Zarin J, Parvataneni H, Desjardin H, Schwappach J, Weingarten P, Weinerman S, Browner K, Newman H, Baker JK, Hurley M, Roberson JR, Erens G, Montelione A, Woodard S, Mullis B, Ertl J, Cummings J, Worman R, Webster M, Shively K, Parr A, Frizzell V, Moore M, Marcantonio AJ, Iorio R, Specht L, Kain M, Wilk R, Garfi J, Torchia M, Cross W, Sems A, Taunton M, Sanchez-Satelo J, Sierrz R, Timm K, Foreman B, DePaolo C, Alosky R, Hill R, Lewis C, Caminiti S, Srivastava A, Jones C, Bakeman J, Ringler J, Sietsema D, Strathy G, Johnson P, Peter K, Morton ME, Parvizi J, Austin M, Morrison T, Mont M, Copeland C, Delanois R, Khanuja H, Weddington S, Bacon M, Mullen M, Kanlic E, Abdelgawad AA, Shunia JG, Mehta S, Ahn J, Horan A, Kaminski C.

Abstract

Patients with hip fractures are older and often present many co-morbidities, including dementia. These patients cannot answer quality of life questionnaires and are generally excluded from trials. We hypothesized that a significant number of patients are being excluded from these studies and this may impact outcomes. This was a two part study; the first analyzing databases of two ongoing large-scale multi-centred hip fracture trials and the second being a systematic review. The FAITH and HEALTH studies were analyzed for exclusion incidence directly related to dementia. The second part consisted of a systematic search of all relevant studies within the last 20 years. In the FAITH study, a total of 1690 subjects were excluded, 375 (22.2%) of which were due to dementia or cognitive impairment. In the HEALTH study, 575 were excluded with dementia/cognitive impairment representing 207 patients (36%). Following the systematic review, 251 articles were identified 17 of which were retained. The overall prevalence of dementia was 27.9% (range 2-51%). Only two studies compared demented and non-demented groups. In these studies significant increases in both mortality and complications were found. In summary, when investigating hip fractures, choosing appropriate objective endpoints is essential to ensure results are also applicable to patients with dementia.

Copyright © 2012 Elsevier Ltd. All rights reserved.

PMID:
22999009
[PubMed - indexed for MEDLINE]
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