Shen et al reported a score for predicting postoperative delirium in an older adult with a hip fracture. This can help to identify a patient who should be monitored more closely. The authors are from Pekin University in Beijing and affiliated institutions.
Patient selection: age >=60 years with hip fracture undergoing surgery repair including hip arthroplasty
Parameters:
(1) preoperative delirium
(2) cerebrovascular accident (CVA) with modified Rankin scale
(3) diabetes with random blood glucose in mmol/L
(4) Charlson Comorbidity Index
(5) age in years
(6) use of benzodiazepines during surgery
(7) surgical delay in days
(8) serum creatinine in µmol/L
(9) active smoker
|
Parameter |
Finding |
Points |
|
preoperative delirium |
no |
0 |
|
|
yes |
4 |
|
CVA |
none |
0 |
|
|
modified Rankin 0 or 1 |
0 |
|
|
modified Rankin 2 or 3 |
2 |
|
|
modified Rankin >= 4 |
3 |
|
diabetes |
no |
0 |
|
|
random glucose < 8 mmol/L |
0 |
|
|
random glucose 8-13 mmol/L |
1 |
|
|
random glucose > 13 mmol/L |
2 |
|
Charlson Comorbidity |
<= 5 |
0 |
|
|
6 to 8 |
1 |
|
|
>= 9 |
2 |
|
age in years |
60 to 69 years |
0 |
|
|
70 to 79 years |
1 |
|
|
>= 80 years |
2 |
|
benzodiazepines |
no |
0 |
|
|
yes |
1 |
|
surgical delay |
< 2 days |
0 |
|
|
>= 2 days |
1 |
|
serum creatinine |
< 90 µmol/L |
0 |
|
|
>= 90 µmol/L |
1 |
|
active smoker |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimal score: 0
• maximum score: 17
|
Score |
Post-Op Delirium |
|
0 |
5% |
|
1 |
6% |
|
2 |
11% |
|
3 |
27% |
|
4 |
33% |
|
5 |
45% |
|
6 |
61% |
|
7 |
62% |
|
8 |
65% |
|
9 |
67% |
|
10 |
70% |
|
11 |
70% |
|
12 |
73% |
|
13 |
75% |
|
14 |
76% |
|
15 |
77% |
|
16 |
81% |
|
17 |
82% |
Performance:
• The area under the ROC curve is 0.85 in the derivation and 0.83 in the validation cohorts.
Specialty: Anesthesiology, Surgery, general
