ASSESSING PREDICTIVE ABILITY OF A PREOPERATIVE SCREEN TO IDENTIFY OLDER ADULTS AT RISK FOR DELIRIUM FOLLOWING ELECTIVE ORTHOPEDIC SURGERY

Abstract

Objective: Post-surgical nursing interventions can reduce but not eliminate the risk of delirium. A preoperative screen for delirium risk which discriminates between those persons at lower versus higher risk of delirium may help future research efforts develop a subject pool for intensive interventions to reduce delirium incidence. The aim of this study is to assess the ability of a previously developed and tested delirium screening tool, the Cleveland Clinic Confusion Score (CCCS), to predict delirium in a select population. Design: Prospective, observational study. Setting/Participants: Convenience sample of 111 adults aged 50 years or older presenting to a preoperative orthopedic clinic. Intervention: We integrated the CCCS into the preoperative evaluation for elective hip and knee surgery. Postoperatively, clinical care nurses screened patients for delirium twice daily using the Nursing Delirium Screening Scale (Nu-DESC). Research nurses gathered additional data regarding postoperative confusion from the chart and family after discharge. Measurements: Primary outcome was the predictive value of the CCCS for delirium. Results: Of the 111 subjects, a positive preoperative CCCS screen was recorded in 31 individuals (27.9%) and postoperative delirium was identified in 12 individuals (10.8%). CCCS assessment in this population had a positive predictive value of 29% and a negative predictive value of 96%. Conclusion: When a delirium screening tool is incorporated into the preoperative process and coupled with a nursing tool for delirium detection, clinicians can identify a subset of older elective orthopedic surgery patients unlikely to develop postoperative delirium. Preoperative delirium screening may help clinicians focus perioperative interventions on higher risk individuals to further reduce delirium risk beyond current, postoperative nursing interventions.