Loss of follow-up in orthopaedic trauma: Is 80% follow-up still acceptable?

Boris A. Zelle, Mohit Bhandari, Alvaro I. Sanchez, Christian Probst, Hans Christoph Pape

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Background: Loss of follow-up represents a potential source of bias. Suggested guidelines propose 20% loss of follow-up as acceptable. However, these guidelines have not been established through scientific investigations. The goal of this study was to evaluate how loss of follow-up influences the statistical significance in a trauma database. Methods: A database of 637 polytrauma patients with an average follow-up of 17.5 years postinjury was used. The functional outcome of workers' compensation patients versus nonworkers' compensation patients was compared using a validated scoring system. A significant difference between the 2 groups was found (P < 0.05). We simulated a gradually increasing loss of follow-up by randomly deleting an increasing number of patients from 2%, 5%, and 10%, and then increasing in increments of 5% until the significance changed. This process was repeated 50 times, each time with a different electronic random generator. For each simulation series, we documented at which simulated loss of follow-up that the results turned from significant (P < 0.05) to nonsignificant (P > 0.05). Results: Among 50 simulation series, the turning point from significant to nonsignificant varied between 15% and 75% loss of follow-up. A simulated loss of follow-up of 10% did not change the statistical significance in any of the simulation series; a simulated loss of follow-up of 20% changed the statistical significance in 28% of our simulation series. Conclusions: A loss of follow-up of 20% or less may frequently change the study results. Researchers should establish protocols to minimize loss of follow-up and clearly state the loss of follow-up in manuscript publications.

Original languageEnglish (US)
Pages (from-to)177-181
Number of pages5
JournalJournal of orthopaedic trauma
Issue number3
StatePublished - Mar 2013


  • Database
  • Loss of follow-up
  • Missing data

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine


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