Abstract
BackgroundAbout 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.MethodsThe 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.ResultsOrthopaedic 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.ConclusionThe 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.
Highlights
About one fourth of patients with hip fracture have cognitive impairment
A study on hip fracture patients without pre-fracture cognitive impairment reported that 38% of the patients that developed delirium during hospitalization were diagnosed with dementia 6 months later [16]
Baseline data and operation methods Of the 1474 hip fracture patients included from the Norwegian Hip Fracture Register (NHFR), 457 (31%) were classified by the surgeon as cognitively impaired and 870 (59%) as cognitively well-functioning
Summary
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. Studies have reported that 19–37% of hip fracture patients have cognitive impairment [3, 4]. Patients with cognitive impairment and dementia are excluded from 8 of 10 hip fracture studies [7]. A study on hip fracture patients without pre-fracture cognitive impairment reported that 38% of the patients that developed delirium during hospitalization were diagnosed with dementia 6 months later [16]. Patients with delirium have increased risk of post-operative complications such as infection, dislocation of hip prostheses and new fractures due to falls [17]. Both patients with dementia and delirium need extra attention during their hospital stay and it is important that surgeons and other health professionals are able to identify these patients early to optimize care and try to minimize risk for complications [12, 18, 19]
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