Infographic on #delirium prevention and management from the American College of Chest Physicians

New Research: Delirium in Hip Fracture Patients Associated with Doubled Mortality Risk I'm pleased to share our new study on delirium and hip fracture, led by @rosespenfold. 91% of all hip fracture patients attending Scottish hospitals had a 4AT delirium assessment tool performed at presentation (N=16,476 ). N=3,386 (21%) had delirium. Key findings: - Delirium was associated with important adverse outcomes including 2-fold higher mortality risks as an inpatient and at one year, and a lower likelihood of returning home following hospital admission. Key implications: - Delirium assessment on initial presentation is feasible at national scale. - Delirium assessment should be performed on presentation of hip fracture. - Hip fracture care without delirium assessment is deficient care. ***Background*** Previous studies have focused primarily on postoperative delirium. This is the first large scale study using routine data to examine delirium ascertained directly with a real-time clinical assessment at the time of hospital admission. ***Methods*** We analysed data from the Scottish Hip Fracture Audit, which covers over 99% of people aged 50+ years hospitalized with acute hip fracture in Scotland. Delirium assessment: 4AT (the4AT.com), which is embedded into routine care and performed by clinical staff. ***Results*** Delirium was present 21% of patients. Patients with delirium were older (mean age 85 vs. 78 years), more likely to be in care homes, and had higher ASA grades. After adjusting for age, sex, pre-fracture residence, and ASA grade, patients with delirium had a 2-fold increased risk of inpatient mortality (adjusted OR 2.26, 95% CI 1.79 to 2.84).The same pattern was observed for one-year mortality (adjusted OR 2.05, 95% CI 1.83 to 2.29). Patients with delirium were less likely to return to their original residence within 30 days (adjusted OR 0.27, 95% CI 0.24 to 0.30) ***Conclusions*** Delirium at hip fracture presentation is a powerful prognostic indicator that can inform shared decision-making with patients and families. Identifying delirium early allows clinicians to address potentially reversible causes and implement appropriate management strategies. Recognition of delirium can help in planning post-acute care needs. Another crucial implication is that we have definitively demonstrated that delirium testing using a validated tool is *feasible in routine practice* in this population. Hip fracture patients must have delirium assessments, and these must be done pre-operatively as well as post-operatively. ***Call to action*** Let's move forward and make good delirium care the norm in hip fracture patients. Let's make system-wide groupthink that it is okay to neglect delirium a thing of the past. Study: boneandjoint.org.uk/article/… #delirium #hipfracture