Incidence and risk factors for acute delirium in older patients with a hip fracture: A retrospective cohort study

Aldwikat, Rami Kamel; Manias, Elizabeth; Nicholson, Patricia

doi:10.1111/nhs.12753

Cited by 10 publications

(9 citation statements)

References 40 publications

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“…Next, the 87 remained studies were carefully full-text-reviewed to recognize those which could reach the inclusion criteria. At last 37 citations (Kagansky et al, 2004 ; Goldenberg et al, 2006 ; Juliebø et al, 2009 ; Chrispal et al, 2010 ; Lee et al, 2011 ; Vochteloo et al, 2011 ; Nie et al, 2012 ; Kim et al, 2013 , 2020 ; Chen et al, 2014 ; Guo et al, 2016 ; Oh et al, 2016 ; Shin et al, 2016 ; van der Zanden et al, 2016 ; Zheng et al, 2016 ; Choi et al, 2017 ; Koskderelioglu et al, 2017 ; Mazzola et al, 2017 ; Arshi et al, 2018 ; Flikweert et al, 2018 ; Levinoff et al, 2018 ; Wang et al, 2018 , 2021 ; Agrawal et al, 2019 ; Harris et al, 2019 ; Ravi et al, 2019 ; Zhang et al, 2019 ; Aldwikat et al, 2020 ; Cho et al, 2020 ; He et al, 2020 ; Uzoigwe et al, 2020 ; Xing et al, 2020 ; Davani et al, 2021 ; Haynes et al, 2021 ; Jeon and Sohng, 2021 ; Oberai et al, 2021 ; Ahn and Bang, 2022 ) were included for further qualitative and quantitative synthesis ( Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…Ten papers (Kagansky et al, 2004 ; Goldenberg et al, 2006 ; Juliebø et al, 2009 ; Nie et al, 2012 ; Koskderelioglu et al, 2017 ; Mazzola et al, 2017 ; Levinoff et al, 2018 ; Zhang et al, 2019 ; Aldwikat et al, 2020 ; Oberai et al, 2021 ) reported preoperative cognitive impairment as a significant risk factor for POD. A random-effects model was applied because significant heterogeneity was found among these studies ( P < 0.00001, I 2 = 83%).…”

Section: Resultsmentioning

confidence: 99%

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Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis

Zou

et al. 2022

Front. Aging Neurosci.

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ObjectivesThis systematic review and meta-analysis was conducted to identify the potential risk factors for postoperative delirium in geriatric patients with hip fracture.MethodsPubMed, EMBASE, and Cochrane Library were searched from inception until December 31st, 2021. A combined searching strategy of subject words and free words was adopted. Studies involving risk factors for postoperative delirium in elderly patients undergoing hip fracture surgeries were reviewed. Qualities of included studies were assessed using the Newcastle–Ottawa Scale. Data were pooled and a meta-analysis was performed using Review Manager 5.3.ResultsA total of 37 studies were included. The following risk factors were significant: advanced age (per year increase) (OR: 1.05, 95% CI 1.04–1.07), age>80 years (OR: 2.26, 95% CI 1.47–3.47), male (OR: 1.53, 95% CI 1.37–1.70), preoperative cognitive impairment (OR:3.20, 95% CI 2.12–4.83), preoperative dementia (OR: 2.74, 95% CI 2.18–3.45), preoperative delirium (OR: 9.23, 95% CI 8.26–10.32), diabetes (OR: 1.18, 95% CI 1.05–1.33), preoperative functional dependence (OR: 1.31, 95% CI 1.11–1.56), ASA level (per level increase) (OR: 1.63, 95% CI 1.04–2.57), ASA level≥3(OR: 1.76, 95% CI 1.39–2.24), low albumin (OR: 3.30, 95% CI 1.44–7.55), medical comorbidities (OR: 1.15, 95% CI 1.06–1.25), Parkinson's disease (OR: 4.17, 95% CI 1.68–10.31) and surgery delay>48 h (OR: 1.90, 95% CI 1.36–2.65).ConclusionsClinicians should be alert to patients with those risk factors. To identify the risk factors more precisely, more research studies with larger sample size and better design should be conducted.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis

Zou

et al. 2022

Front. Aging Neurosci.

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“…Delirium assessment was also conducted twice daily in the patients’ rooms at approximately 08:00 and 18:00 for the first five post-operative days. Data collection in the postoperative period was based on a recent study by Aldwikat [ 25 ], involving 260 patients aged 65 years or older, where it was identified that 100% of post-operative delirium cases developed during the first five post-operative days. Assessment with the reference standard took place within a few minutes of conducting the index tests.…”

Section: Methodsmentioning

confidence: 99%

Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study

Aldwikat

Manias

Holmes

et al. 2022

IJERPH

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(1) Background: Delirium is a common complication among surgical patients after major surgery, but it is often underdiagnosed in the post-anaesthetic care unit (PACU). Valid and reliable tools are required for improving diagnoses of delirium. The objective of this study was to evaluate the diagnostic test accuracy of the Three-Minute Diagnostic Interview for Confusion Assessment Method (3D-CAM) and the 4A’s Test (4AT) as screening tools for detection of delirium in older people in the PACU. (2) Methods: A prospective diagnostic test accuracy study was conducted in the PACU and surgical wards of a university-affiliated tertiary care hospital in Victoria, Australia. A consecutive prospective cohort of elective and emergency patients (aged 65 years or older) admitted to the PACU were recruited between July 2021 and December 2021 following a surgical procedure performed under general anaesthesia and expected to stay in the hospital for at least 24 h following surgery. The outcome measures were sensitivity, specificity positive predictive value and negative predictive value for 3D-CAM and 4AT. (3) Results: A total of 271 patients were recruited: 16.2% (44/271) had definite delirium. For a diagnosis of definite delirium, the 3D-CAM (area under curve (AUC) = 0.96) had a sensitivity of 100% (95% CI 92.0 to 100.0) in the PACU and during the first 5 days post-operatively. Specificity ranged from 93% (95% CI 87.8 to 95.2) to 91% (95% CI 85.9 to 95.2) in the PACU and during the first 5 days post-operatively. The 4AT (AUC = 0.92) had a sensitivity of 93% (95% CI 81.7 to 98.6) in the PACU and during the first 5 days post-operatively, and specificity ranged from 89% (95% CI 84.6 to 93.1) to 87% (95%CI 80.9 to 91.8) in the PACU and during the first 5 days post-operatively. (4) Conclusions: The 3D-CAM and the 4AT are sensitive and specific screening tools that can be used to detect delirium in older people in the PACU. Screening with either tool could have an important clinical impact by improving the accuracy of delirium detection in the PACU and hence preventing adverse outcomes associated with delirium.

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“…Analogously, four observational studies have shown an incidence of delirium of 15.7% [34], 22,09% [35], 24.2% [36] and 31.1% [37]. Poeran et al associated postoperative delirium with long-acting and combined short and long-acting benzodiazepines and ketamine while neuraxial anaesthesia and opioid use were associated with lower risk [34].…”

Section: Geriatric Syndromes Deliriummentioning

confidence: 97%

“…Tao et al identified baseline Barthel index, Mini-Mental State Examination (MMSE), instrumental activities of daily living (IADLs), and Geriatric Depression Scale (GDS) as risk factors for delirium [35]. Aldwikat et al found that comorbidity and cognitive impairment were independent risk factors for the development of delirium [36]. Finally, Pioli et al linked risk of delirium to older age, higher degree of comorbidity and functional impairment [37].…”

Section: Geriatric Syndromes Deliriummentioning

confidence: 99%

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

Tarazona-Santabalbina

Ojeda-Thies

Rodríguez

et al. 2021

IJERPH

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Hip fractures are an important socio-economic problem in western countries. Over the past 60 years orthogeriatric care has improved the management of older patients admitted to hospital after suffering hip fractures. Quality of care in orthogeriatric co-management units has increased, reducing adverse events during acute admission, length of stay, both in-hospital and mid-term mortality, as well as healthcare and social costs. Nevertheless, a large number of areas of controversy regarding the clinical management of older adults admitted due to hip fracture remain to be clarified. This narrative review, centered in the last 5 years, combined the search terms “hip fracture”, “geriatric assessment”, “second hip fracture”, “surgery”, “perioperative management” and “orthogeriatric care”, in order to summarise the state of the art of some questions such as the optimum analgesic protocol, the best approach for treating anemia, the surgical options recommendable for each type of fracture and the efficiency of orthogeriatric co-management and functional recovery.

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Incidence and risk factors for acute delirium in older patients with a hip fracture: A retrospective cohort study

Cited by 10 publications

References 40 publications

Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis

Risk factors for postoperative delirium in geriatric patients with hip fracture: A systematic review and meta-analysis

Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study

Orthogeriatric Management: Improvements in Outcomes during Hospital Admission Due to Hip Fracture

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