Penfold Rose S, Farrow Luke, Hall Andrew J, Clement Nick D, Ward Kirsty, Donaldson Lorraine, Johansen Antony, Duckworth Andrew D, Anand Atul, Hall Daniel E, Guthrie Bruce, MacLullich Alasdair M J
Edinburgh Delirium Research Group, Ageing and Health, Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK.
Bone Joint J. 2025 Apr 1;107-B(4):470-478. doi: 10.1302/0301-620X.107B4.BJJ-2024-1164.R1.
Delirium is common in hip fracture patients, but large-scale routine data studies examining the prevalence and associations of delirium at the time of initial presentation with a hip fracture are rare. This study aimed to describe the prevalence and outcomes of delirium on initial presentation with a hip fracture in a large national population sample.
This study analyzed routinely collected national clinical registry data for all people in Scotland aged 50 years and over presenting with a hip fracture between 1 July 2019 and 31 December 2021. Delirium was assessed prospectively by clinicians as part of routine care using the 4AT, a validated two-minute assessment tool. Associations of 4AT score with mortality and return home within 30 days were analyzed using logistic regression models, adjusted for confounders.
Of 18,040 patients (mean age 80 years (SD 10); 70% female (n = 12,594)), 16,476 (91%) had a 4AT assessment on presentation and of these, 3,386 (21%) had a score ≥ 4, suggestive of delirium. Patients with delirium were older, more likely residing in care homes, and had higher American Society of Anesthesiologists grades (all p < 0.001). Delirium was independently associated with a twofold increased risk of inpatient mortality (adjusted odds ratio (aOR) 2.26 (95% CI 1.79 to 2.84)) and one-year mortality (aOR 2.05 (95% CI 1.83 to 2.29)), and a lower likelihood of returning home within 30 days (aOR 0.27 (95% CI 0.24 to 0.30)).
Delirium affects around 20% of patients presenting with a hip fracture, and is associated with important adverse outcomes. Integrating delirium assessment into the initial clinical assessment of hip fracture patients is feasible at national scale, and should be considered as part of care for all hip fracture patients.
谵妄在髋部骨折患者中很常见，但针对髋部骨折初次就诊时谵妄的患病率及相关因素进行的大规模常规数据研究却很少见。本研究旨在描述在一个大型全国性人群样本中，髋部骨折初次就诊时谵妄的患病率及预后情况。
本研究分析了2019年7月1日至2021年12月31日期间，苏格兰所有年龄在50岁及以上、因髋部骨折就诊的人群的常规收集的国家临床登记数据。谵妄由临床医生在常规护理过程中使用4AT进行前瞻性评估，4AT是一种经过验证的两分钟评估工具。使用逻辑回归模型分析4AT评分与死亡率及30天内回家情况的相关性，并对混杂因素进行了调整。
在18040名患者中（平均年龄80岁（标准差10）；70%为女性（n = 12594）），16476名（91%）患者在就诊时进行了4AT评估，其中3386名（21%）评分≥4，提示存在谵妄。谵妄患者年龄更大，更有可能居住在养老院，美国麻醉医师协会分级更高（所有p < 0.001）。谵妄与住院死亡率增加两倍（调整后的比值比（aOR）2.26（95%置信区间1.79至2.84））和一年死亡率增加（aOR 2.05（95%置信区间1.83至2.29））独立相关，且30天内回家的可能性更低（aOR 0.27（95%置信区间0.24至0.30））。
谵妄影响约20%的髋部骨折患者，并与重要的不良预后相关。将谵妄评估纳入髋部骨折患者的初始临床评估在全国范围内是可行的，应被视为所有髋部骨折患者护理的一部分。
