Prediction Models for Postoperative Deep Vein Thrombosis in Elderly Hip Fracture Patients: A Systematic Review

Abstract

Objective: To systematically evaluate prediction models for postoperative deep vein thrombosis (DVT) in elderly hip fracture patients and assess their methodological quality and predictive performance. Methods: Following PRISMA guidelines, we searched eight databases (PubMed, Embase, Cochrane Library, Web of Science, CINAHL, CNKI, Wanfang, VIP) from inception to May 2025. Studies developing or validating DVT prediction models in elderly hip fracture patients were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias and applicability using the PROBAST tool. Results: Eleven studies were included, all conducted in China between 2021 and 2025. Sample sizes ranged from 101 to 504 patients (total n = 3,286). Models incorporated 3 to 9 predictors, with D-dimer, age, and time from injury to surgery being most common. All 11 studies (100%) were rated as high risk of bias, primarily due to small sample sizes, lack of validation, and inadequate missing data handling. Applicability concerns were low in 8 studies (72.7%). AUC values ranged from 0.648 to 0.967, with 10 studies (90.9%) reporting AUC > 0.7. Meta-analysis identified time from injury to surgery (OR = 4.63, 95% CI: 2.58–6.68), age (OR = 1.99), D-dimer (OR = 1.51), and Caprini score (OR = 1.75) as significant predictors. Conclusion: Current DVT prediction models for elderly hip fracture patients demonstrate acceptable discrimination but are limited by high risk of bias and lack of external validation. Prospective, multicenter studies with rigorous validation are needed to develop clinically applicable models.