R S Penfold, A J Hall, A Anand, A D Duckworth, N D Clement, A M J MacLullich

1527 DELIRIUM ON HOSPITAL ADMISSION IS ASSOCIATED WITH ADVERSE OUTCOMES IN PATIENTS WITH A HIP FRACTURE: THE IMPACT DELIRIUM STUDY

  • Geriatrics and Gerontology
  • Aging
  • General Medicine
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Abstract Aim Delirium is associated with adverse outcomes following hip fracture, but large-scale routine data studies investigating pre-operative delirium are lacking. Our aims were to assess delirium prevalence on hospital admission and, in patients admitted from home, determine associations with: (i) mortality; (ii) length of stay; (iii) post-discharge level of care, and (iv) hospital readmission within 180 days. Methods This retrospective cohort study was conducted in a major trauma centre using routine clinical records and validated audit data. Consecutive patients aged ≥50 years admitted with a hip fracture between 01/03/20-30/11/21 were included. Admission delirium status was determined by 4’A’s Test score≥4. Patients with missing scores were excluded. Associations of delirium with mortality, discharge to higher care and readmission with 180-day follow-up were assessed using multivariable logistic regression adjusted for age, sex, deprivation, and ASA grade. Results A total of 1821 patients (mean age 80.7 years; 71.7% female) were admitted, 1383 (mean age 79.5; 72.1% female) from home. 87 patients (4.8%) were excluded due to missing 4AT scores. Delirium prevalence in the whole cohort was 26.5% (460/1734): 14.1% (189/1340) in patients from home, 68.8% (271/ 394) in the remaining patients. In home-dwelling patients, delirium was associated with a 3 day longer median acute stay (p<0.001). In multivariable analyses, delirium was independently associated with higher mortality at 180 days (Odds Ratio (OR) 1.69, 95% Confidence Interval (CI) 1.13-2.54; p=0.013), discharge to higher care (OR 2.82, CI 1.99-4.00; p<0.001), and readmission within 180 days (OR 1.77, CI 1.01-3.11; p=0.046). Conclusions More than one in four patients had delirium on admission. More than one in seven admitted from home had delirium; this was associated with adverse outcomes. Routine admission delirium assessment could guide prognostication, targeted peri-operative management, and proactive care planning. Research should focus on identifying potentially modifiable risk factors and mediators of adverse outcomes following delirium.

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