A 94-year-old man with dementia and severe systemic diseases with a constant threat to life presents to the emergency department several hours after a slip and fall at the nursing home where he lives. At the emergency department, he complained of pain in his left leg and was unable to stand on this leg. The leg was shortened and externally rotated. A plain radiograph of the hip revealed a trochanteric proximal femoral fracture. Laboratory tests revealed a hemoglobin level of 5.3 mmol/l

His daughter inquired about treatment options. To inform the patient and his daughter about the prognosis and start the shared decision-making process, the emergency department physician calculated the risk of early mortality using the AHFS90

Predicting the risk of early mortality with the AHFS90

The patient’s scores on the AHFS90 were as follows:

Age in years = 94

Gender = 0

Dementia = 1

Nursing Home = 1

ASA4 = 1

Hb in mmol/l = 5.3

${\mathrm{AHFS}}^{90}=-8.872+0.085\bullet 94-0.906\bullet 0+0.586\bullet 1+0.593\bullet 1+0.836\bullet 0+1.704\bullet 1-0.219\bullet 5.3$

$\mathrm{AHFS}90=0.840$

$\mathrm{Risk}\mathrm{of}\mathrm{early}\mathrm{mortality}\left(\%\right)=\frac{100}{1+{\mathrm{e}}^{-0.840}}=69.9\%$