Can We Predict Prognosis After Hip Fracture? A Review of GSF Accuracy in Orthogeriatric Patients

Background:
The Gold Standards Framework (GSF) is a nationally recognised tool used to identify patients approaching the end-of-life and facilitate advances care planning (ACP). Accurate GSF assignment can improve ACP, support preferred place of care and death, and reduce unnecessary admissions. Mortality following hip fracture is currently 6% within one month and varies from 12.1%-35.8 % globally at one year, making accurate prognostication particularly important in orthogeriatric populations. We therefore evaluated the accuracy of GSF assignment in patients aged over 60 years admitted with neck of femur fractures (NOFs) to Lister Hospital.

Methods:
We reviewed 502 patients admitted with NOFs between January and December 2024. 24 patients who died during admission were excluded. GSF status assigned by the multi-disciplinary team was compared with a corrected GSF derived from survival following discharge: Blue (>1 year), Green (3–12 months), Amber (2 weeks–3 months) and Red (<2 weeks). Ninety patients (18.8%) had no documented GSF, leaving 388 patients for analysis.

Results:
Of 388 patients with a documented GSF, 267 (68.8%) were assigned the correct category. Prognosis was overestimated in 71 patients (18.3%) and underestimated in 50 patients (12.9%). Among the 90 patients without a documented GSF, 25 had died by follow-up; of these, 7 (7.8%) met green criteria and 7 (7.8%) Amber criteria. Overall, only 56% of the total cohort received a correct GSF assignment including patients with no documented GSF. 

Conclusions:
Significant opportunities exist to improve prognostication in orthogeriatric patients. Under-recognition and failure to assign GSF may result in unmet palliative care needs, while overestimation of need may place unnecessary pressure on limited resources. Routine MDT discussion, improved documentation, and enhanced staff education may improve GSF accuracy and patient-centred care. Future work will explore additional predictors of prognosis, including changes in Rockwood scores and communication of GSF status in discharge documentation.