Clock-Drawing Test as a Bedside Assessment of Post-operative Delirium Risk in Elderly Patients with Accidental Hip Fracture
Currently applied cognitive tests for assessing the risk of post-operative delirium require time and specialised medical staff, in addition to the patients’ mental strain. We investigated the four-point scoring Clock-Drawing Test (CDT-4) as a preoperative independent predictor for post-operative delirium.
A total of 100 consecutive patients aged over 65 years admitted for accidental hip fracture were assessed for delirium using the Confusion Assessment Method Scale. The cognitive function was rated with mini–mental state examination, Montreal Cognitive Assessment Scale (MoCA), and CDT-4. Descriptive statistics were performed, and a logistic regression model for post-operative delirium was applied.
Out of the 100 enrolled patients 98 underwent hip repair surgery and 65 (66%) had post-operative delirium, with 24 (42%) incident cases. The median (IQR) ages were 78 (72–83) and 84 (80–87) years for the non-delirium and post-operative delirium groups, respectively. The logistic regression concluded with age and CDT-4 as independent preoperative predictors, while controlling for gender, pre-surgery delirium, MoCA visual, and MoCA attention: OR 1.32 [95% CI (1.099–1.585); p = 0.003] for age; OR 0.153 [95% CI (0.033–0.719); p = 0.017] for CDT-4.
Employing CDT-4 as a bedside assessment of delirium risk may help to preoperatively stratify and prioritise the patients for preventive perioperative care in a timely manner.
The first author’s doctoral research was funded by the Ph.D. Grant Number I-C3-GD-2014.
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Conflict of interest
- 1.American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn (DSM-5). doi: 10.1176/appi.books.9780890425596.744053. Accessed 26 Jun 2017
- 3.American Academy of Orthopaedic Surgeons (2015) Hip fracture patients: nearly half have delirium, study suggests. ScienceDaily. www.sciencedaily.com/releases/2015/03/150324084949.htm. Accessed 26 Jun 2017
- 5.Tsuruta R, Oda Y (2016) A clinical perspective of sepsis associated delirium. J Intensive Care 4(18):1–7Google Scholar
- 16.Machado KL, Domiciano DS, Machado LG et al (2015) Persistent hypovitaminosis D and loss of hip bone mineral density over time as additional risk factors for recurrent falls in a population-based prospective cohort of elderly persons living in the community. The São Paulo Ageing & Health (SPAH) Study. Osteoporosis Int 26(5):1535–1542CrossRefGoogle Scholar