Delirium in older people after proximal femoral fracture repair: Role of a preoperative screening cognitive test

Mézière, Anthony; Paillaud, Éléna; Belmin, Joël; Pariel, Sylvie; Herbaud, Stéphane; Canouï‐Poitrine, Florence; Thuaut, Aurélie Le; Marty, J.; Plaud, Benoît

doi:10.1016/j.annfar.2013.06.006

Cited by 20 publications

(12 citation statements)

References 26 publications

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“…Results showed that a brief cognitive screen -which included a three-word recall test, simplified clock drawing, and spatial orientation -predicted the risk of postoperative delirium in a univariate analysis and after adjustment for age. 7 Our results are in agreement with the conclusion of that study: that a limited cognitive screen such as a one-minute fluency test can be prognostically useful for identifying patients at risk of developing postoperative delirium. One potential advantage of the AFT -in contrast to other cognitive screens, such as the Mini Cog 8 -is that it can be administered in person or over the telephone.…”

Section: Discussionsupporting

confidence: 92%

Sensitivity and specificity of the animal fluency test for predicting postoperative delirium

Long

Wolpaw

Leung

2014

Can J Anesth/J Can Anesth

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Background Preoperative cognitive impairment is a major risk factor for postoperative delirium. We therefore investigated the prognostic significance and feasibility of administering a brief cognitive screen before surgery. Methods Patients [ 65 yr of age undergoing hip, knee, or spine surgery were enrolled. A 60-sec cognitive screen, the animal fluency test (AFT), was administered preoperatively. Postoperative delirium was measured using a chart-based tool previously validated using criteria from the Confusion Assessment Method. Results Of the 362 patients satisfying the inclusion/ exclusion criteria, 199 (55%) underwent the AFT. Among them, 57 patients (29%) had an AFT score \ 15, and 38 patients (19%, 95% confidence interval [CI]: 14 to 25%) developed postoperative delirium as measured by chart review. Patients with scores of \ 15 were more likely to develop postoperative delirium than those who scored C 15 (54% vs 5%, P \ 0.01). A multiple logistic regression, with postoperative delirium as the dependent variable, identified an AFT score of \ 15 (odds ratio 20.1, 95% CI: 7.9 to 51.4) and high American Society of Anesthesiologists classification (odds ratio 3.5, 95% CI: 1.3 to 9.2) as independent predictors. Conclusions The AFT is a potentially useful brief cognitive screen for identifying patients at risk of developing postoperative delirium. Limited participation by eligible participants in this study, however, raises questions about how useful and feasible systematic administration of the test is. Large studies using prospective measurement of postoperative delirium are indicated to validate our results. Résumé

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Section: Discussionsupporting

confidence: 92%

Sensitivity and specificity of the animal fluency test for predicting postoperative delirium

Long

Wolpaw

Leung

2014

Can J Anesth/J Can Anesth

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“…Participants lost to follow-up were documented in five papers (Bitsch et al, 2006;Björkelund et al, 2011;Luger et al, 2014;Wang et al, 2008;Westhoff et al, 2013), accounting for 88 participants in total. From those who experienced delirium, mean age ranged from 73.7 years (Chrispal et al, 2010;Radinovic et al, 2014) to 88.3 years (Mézière et al, 2013), whilst in the non-delirium group, mean age ranged from 71.3 years (Chrispal et al, 2010) to 88.4 years (Luger et al, 2014).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Factors predicting incidence of post‐operative delirium in older people following hip fracture surgery: a systematic review and meta‐analysis

Smith

Cooper

Peryer

et al. 2017

Int J Geriat Psychiatry

126

104

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Objective: Delirium is one of the most common complications following hip fracture surgery in older people. This study identified pre-and peri-operative factors associated with the development of post-operative delirium following hip fracture surgery. Methods:Published and unpublished literature were searched to identify all evidence reporting variables on patient characteristics, on-admission, intra-operative and post-operative management assessing incident delirium in older people following hip fracture surgery. Pooled odds ratio (OR) and mean difference (MD) of those who experienced delirium compared to those who did not were calculated for each variable. Evidence was assessed using the Downs and Black appraisal tool and interpreted using the GRADE approach.Results: 6704 people (2090 people with post-operative delirium) from 32 studies were analysed.There was moderate evidence of nearly a two-times greater probability of post-operative delirium for those aged 80 years and over (OR: 1.77; 95% CI: 1.09, 2.87), whether patients lived in a care institution pre-admission (OR: 2.65; 95% CI: 1.79, 3.92), and a six-times greater probability of developing post-operative delirium with a pre-admission diagnosis of dementia (OR: 6.07, 95% CI: 4.84, 7.62). There was no association with intra-operative variables and probability of delirium. Conclusion:Clinicians treating people with a hip fracture should be vigilant towards postoperative delirium if their patients are older, have pre-existing cognitive impairment and poorer overall general health. This is also the case for those who experience post-operative complications such as pneumonia or a urinary tract infection.

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“…Codex has also found other applications, for example, in predicting postoperative delirium in patients undergoing femoral fracture repair [8] and in monitoring cognitive impairment before and after cochlear implantation surgery [9]. Codex was included as part of the protocol of the EVATEM study for the detection of cognitive disorders amongst community-dwelling elderly people with memory complaints [10].…”

Section: Introductionmentioning

confidence: 99%

Codex (Cognitive Disorders Examination) Decision Tree Modified for the Detection of Dementia and MCI

Ziso

Larner

2019

Diagnostics

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Many cognitive screening instruments are available to assess patients with cognitive symptoms in whom a diagnosis of dementia or mild cognitive impairment is being considered. Most are quantitative scales with specified cut-off values. In contrast, the cognitive disorders examination or Codex is a two-step decision tree which incorporates components from the Mini-Mental State Examination (MMSE) (three word recall, spatial orientation) along with a simplified clock drawing test to produce categorical outcomes defining the probability of dementia diagnosis and, by implication, directing clinician response (reassurance, monitoring, further investigation, immediate treatment). Codex has been shown to have high sensitivity and specificity for dementia diagnosis but is less sensitive for the diagnosis of mild cognitive impairment (MCI). We examined minor modifications to the Codex decision tree to try to improve its sensitivity for the diagnosis of MCI, based on data extracted from studies of two other cognitive screening instruments, the Montreal Cognitive Assessment and Free-Cog, which are more stringent than MMSE in their tests of delayed recall. Neither modification proved of diagnostic value for mild cognitive impairment. Possible explanations for this failure are considered.

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Delirium in older people after proximal femoral fracture repair: Role of a preoperative screening cognitive test

Cited by 20 publications

References 26 publications

Sensitivity and specificity of the animal fluency test for predicting postoperative delirium

Sensitivity and specificity of the animal fluency test for predicting postoperative delirium

Factors predicting incidence of post‐operative delirium in older people following hip fracture surgery: a systematic review and meta‐analysis

Codex (Cognitive Disorders Examination) Decision Tree Modified for the Detection of Dementia and MCI

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