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.
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