Incidence, clinical features and subtypes of delirium in elderly patients treated for hip fractures.
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.
Santana Santos
Franklin
F
NEUROTEC Department, Huddinge Hospital, Karolinska Institute, Stockholm, Sweden. franklinssantos@hotmail.com
Wahlund
Lars Olof
LO
Varli
Ferid
F
Tadeu Velasco
Irineu
I
Eriksdotter Jonhagen
Maria
M
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
D006993:Hypnotics and Sedatives; D008874:Midazolam