Validation and Adaptation of the Nottingham Hip Fracture Score to Predict 30-Day and 1-Year Mortality Among Italian Older Adults Hospitalized Due to Hip Fractures

Sep 30, 2026

Older adults with hip fractures represent a clinically heterogeneous population with substantial risk of adverse outcomes, creating pressure on healthcare delivery and economic systems. Prognostic tools estimating 30-day and 1-year mortality can support more precise management decisions. This study validates the Nottingham Hip Fracture Score (NHFS) in an Italian cohort and improves its predictive ability for 30-day and 1-year mortality using prospective observational data, logistic regression, ROC analysis, and a developed nomogram.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Background/Objectives

Methods

Results

Conclusions

Introduction

Epidemiology and clinical burden

Mortality and disability after hip fracture

Risk stratification tools and rationale

Article Validation and Adaptation of the Nottingham Hip Fracture Score to Predict 30-Day and 1-Year Mortality Among Italian Older Adults Hospitalized Due to Hip Fractures Valentina Gemo 1,2, Vittorio Bini 1, Ilaria G. Macchione 1, Lorenzo Lucchetta 3, Chiara Properzi 1, Federica Perini 1,2, Marta Baroni 1, Paola Montanari 4, Chiara Merenda 5, Fabio Gori 5, Barbara Bifarini 5, Enrico Iotti 6, Lorenzo Di Giacomo 3, Sabrina Ronzoni 4, Chiara Bendini 4, Paolo Pignedoli 7, Giuseppe Rinonapoli 3 and Carmelinda Ruggiero 1, * Academic Editor: Johannes Dominik Bastian Received: 5 November 2025 Revised: 29 November 2025 Accepted: 16 December 2025 Published: 31 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Orthogeriatric and Geriatric Units, Gerontology and Geriatrics Section, Department of Medicine and Surgery, University of Perugia, S. Maria Misericordia Hospital, S. Andrea delle Fratte, 06132 Perugia, Italy 2 Orthogeriatric and Geriatric Units, Degli Infermi Hospital, 48018 Faenza, Italy 3 Orthopaedics and Traumatology Units, Department of Medicine and Surgery, University of Perugia, S. Maria Misericordia Hospital, S. Andrea delle Fratte, 06132 Perugia, Italy 4 Orthogeriatrics, Neuromotor and Rehabilitation Department, Arcispedale S. Maria Nuova, 42121 Reggio Emilia, Italy 5 Anaesthesia and Resuscitation, Department of Medicine and Surgery, S. Maria Misericordia Hospital, S. Andrea delle Fratte, 06132 Perugia, Italy 6 Anaesthesia and Resuscitation Units, Franchini di Montecchio Emilia Hospital, 42121 Reggio Emilia, Italy 7 Orthopaedics and Traumatology, Arcispedale S. Maria Nuova, 42121 Reggio Emilia, Italy * Correspondence: [carmelinda.ruggiero@unipg.it; Tel.: +39-075-578-3525/3839; Fax: +39-075-578-3878](carmelinda.ruggiero@unipg.it; Tel.: +39-075-578-3525/3839; Fax: +39-075-578-3878) Abstract Background/Objectives: Older people with hip fractures (HF) are highly heterogeneous patients at risk of adverse events, which impacts healthcare and economic systems. Tools for estimating 30-day and 1-year mortality may help optimize patient management decisions. The Nottingham Hip Fracture Score (NHFS) is one of the most reliable tools for assessing 30-day mortality after surgery. The aim is to validate the NHFS in a cohort of Italian patients hospitalized due to HF and enhance its predictive capacity against 30-day and 1-year mortality. Methods: A prospective observational study among older patients with HF who underwent surgery after a comprehensive geriatric assessment (CGA) . Data about 30-day and 1-year mortality were gathered from regional registries. Logistic regression analyses were performed to assess the predictive accuracy of the NHFS against 30-day and 1-year mortality. The adapted scores were measured using ROC curves, and a nomogram was developed. Result: Among 1169 patients, 30-day and 1-year mortality rates were 4.3% and 21.3%, respectively. The NHFS was validated and recalibrated in the study sample for 30-day mortality. The recalibrated NHFS showed better predictive capacity for 30-day mortality (AUC 0.693) than the ASA score (AUC 0.547) and remained a significant predictor for 1-year mortality (AUC 0.712) . BADL and METs showed an association with mortality, so the modified NHFS was integrated, resulting in a more accurate prediction compared to the original score for 1-year mortality (AUC = 0.747) . Conclusions: The NHFS is a reliable tool for estimating 30-day and 1-year mortality in Italian older adults with HF. The revised NHFS, which includes METs and BADL, offers higher predictive power than the original version in our sample, and the nomogram may facilitate its clinical use. Keywords: hip fracture; mortality; NHFS; orthogeriatrics; functional performance 1. Introduction Osteoporosis is a major publ

FAQs

What is the purpose of validating the Nottingham Hip Fracture Score (NHFS) in this study?

To validate the NHFS for predicting 30-day and 1-year mortality in Italian patients hospitalized due to hip fractures, and to enhance its predictive capacity against these outcomes.

How was mortality prediction assessed for 30-day and 1-year mortality?

The study used logistic regression to evaluate predictive accuracy, ROC curves to measure adapted score performance, and developed a nomogram for clinical use.

What changes were made to improve prediction accuracy, and what was the impact?

The recalibrated NHFS improved 30-day mortality prediction and remained a significant predictor for 1-year mortality; incorporating METs and BADL produced a more accurate prediction for 1-year mortality compared with the original score.

Sep 30, 2026

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