Norwegian Hip Fracture Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Jonas Lies vei 65, N 5021, Bergen, Norway.
Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsveien 28, N 5009, Bergen, Norway.
BMC Musculoskelet Disord. 2019 Jun 1;20(1):268. doi: 10.1186/s12891-019-2633-x.
About one fourth of patients with hip fracture have cognitive impairment. These patients are at higher risk of surgical and medical complications and are often excluded from participating in clinical research. The aim of the present study was to investigate orthopaedic surgeons' ability to determine the cognitive status of patients with acute hip fracture and to compare the treatment given to patients with and without cognitive impairment.
The cognitive function of 1474 hip fracture patients reported by the orthopaedic surgeons to the nationwide Norwegian Hip Fracture Register was compared with data registered in quality databases in two hospitals with orthogeriatric service on the same patients. Cognitive function registered in the quality databases was determined either by the short form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) or by pre-fracture diagnosis of dementia. The information registered in the quality databases was defined as the reference standard. Cognitive function in the Norwegian Hip Fracture Register was reported as: Chronic cognitive impairment? "Yes", "Uncertain" or "No" by the orthopaedic surgeons. Sensitivity, specificity, negative and positive predictive values for chronic cognitive impairment reported to the Norwegian Hip Fracture Register by the orthopaedic surgeons was calculated. Baseline data and treatment of hip fractures in patients with and without cognitive impairment in the Norwegian Hip Fracture Register were compared.
Orthopaedic surgeons reported chronic cognitive impairment in 31% of the patients. Using documented dementia or IQCODE > 4.0 as the reference, this assessment of cognitive impairment by the orthopaedic surgeons had a sensitivity of 69%, a specificity of 90%, a positive predictive value of 78%, and a negative predictive value of 84% compared to information registered in the two hospital quality databases. There were no differences in type of hip fracture or type of surgical treatment by cognitive function.
The treatment of hip fractures was similar in patients with chronic cognitive impairment and cognitively well-functioning patients. The surgeons had an acceptable ability to identify and report chronic cognitive impairment in the peri-operative period, indicating that the Norwegian Hip Fracture Register is a valuable resource for future registry-based research also on hip fracture patients with chronic cognitive impairment.
约四分之一髋部骨折患者存在认知障碍。这些患者发生手术和医疗并发症的风险更高，往往被排除在临床研究之外。本研究旨在调查骨科医生确定急性髋部骨折患者认知状态的能力，并比较有认知障碍和无认知障碍患者的治疗情况。
比较骨科医生向全国挪威髋部骨折登记处报告的 1474 例髋部骨折患者的认知功能，以及两家具有矫形老年服务的医院质量数据库中登记的同一患者的数据。质量数据库中登记的认知功能通过简易认知衰退问卷（IQCODE）短表或骨折前痴呆诊断确定。质量数据库中登记的信息被定义为参考标准。挪威髋部骨折登记处报告的认知功能由骨科医生报告为：慢性认知障碍？“是”、“不确定”或“否”。计算骨科医生报告的挪威髋部骨折登记处慢性认知障碍的敏感性、特异性、阴性和阳性预测值。比较挪威髋部骨折登记处有认知障碍和无认知障碍患者的基线数据和髋部骨折治疗情况。
骨科医生报告 31%的患者存在慢性认知障碍。使用有记录的痴呆或 IQCODE>4.0 作为参考，骨科医生对认知障碍的评估敏感性为 69%，特异性为 90%，阳性预测值为 78%，阴性预测值为 84%，与两家医院质量数据库登记的信息相比。认知功能对髋部骨折类型或手术治疗类型无影响。
髋部骨折患者的治疗在慢性认知障碍和认知功能良好的患者中相似。外科医生在围手术期识别和报告慢性认知障碍的能力可接受，表明挪威髋部骨折登记处是未来基于登记处的研究，包括慢性认知障碍髋部骨折患者的宝贵资源。
