title: Incidence, clinical features and subtypes of delirium in elderly patients treated for hip fractures.
abstract: OBJECTIVE
  To describe the incidence, risk factors and clinical features (subtypes) of delirium during the postoperative period after hip fracture surgery in elderly patients.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Thirty-four consecutive patients (9 men and 25 women) were included in this study between June 16 to July 14, 2003. All patients underwent surgery for a fractured neck of femur and were pre- and postoperatively cared for at a combined geriatric/orthopedic ward.
  
  
  RESULTS
  The diagnosis of delirium was based on the criteria of the DSM-IV and the Confusion Assessment Method Scale. Subtypes of delirium were classified according to the criteria proposed by Lipowski: hyperactive-hyperalert (or agitated), hypoactive-hypoalert (somnolent) and mixed delirium.
  
  
  RESULTS
  Fifty-five percent (n = 19) of the 34 patients developed delirium after surgery. The development of delirium was associated with the medication midazolam taken perioperatively. Nine (47%) of the delirious patients had a hyperactive type of delirium; 5 (26%) developed a hypoactive delirium, and 5 (26%) had a mixed type. We did not find any association among subtypes of delirium and clinical features.
  
  
  CONCLUSIONS
  Delirium is a common complication in the postoperative period of elderly patients treated for hip fractures. The use of midazolam in the perioperative period increased the risk of developing postoperative delirium. The hyperactive type of delirium was the most common subtype of delirium.
authors.affiliation: NEUROTEC Department, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden. franklinssantos@hotmail.com
authors.forename: Franklin
authors.initials: F
authors.lastname: Santana Santos
authors.forename: Lars Olof
authors.initials: LO
authors.lastname: Wahlund
authors.forename: Ferid
authors.initials: F
authors.lastname: Varli
authors.forename: Irineu
authors.initials: I
authors.lastname: Tadeu Velasco
authors.forename: Maria
authors.initials: M
authors.lastname: Eriksdotter Jonhagen
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000523:psychology; D006620:Hip Fractures / Q000150:complications / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008297:Male; D008874:Midazolam / Q000009:adverse effects; D008875:Middle Aged; D009735:Nursing Homes; D011183:Postoperative Complications / Q000453:epidemiology* / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012737:Sex Factors
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam