title: Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium.
abstract: BACKGROUND
  Delirium in patients with hip fractures lead to higher morbidity and mortality. Prevention in high-risk patients by prescribing low dose haloperidol is currently under investigation.
  
  
  METHODS
  This prospective cohort surveillance assessed hip fracture patients for risk of developing a delirium with the Risk Model for Delirium (RD) score. High-risk patients (score ≥ 5 points) were treated with a prophylactic low-dose of haloperidol according to hospital protocol. Primary outcome was delirium incidence. Secondary outcomes were differences between high- and low-risk patients in delirium, length of stay (LOS), return to pre-fracture living situation and mortality. Logistic regression analysis was performed with age, ASA-classification, known dementia, having a partner, type of fracture, institutional residence and psychotropic drug use as possible confounders.
  
  
  RESULTS
  445 hip fracture patients aged 65 years and older were admitted from January 2008 to December 2009. The RD-score was completed in 378 patients, 173 (45.8%) high-risk patients were treated with prophylactic medication. Sensitivity was 71.6%, specificity 63.8% and the negative predictive value (NPV) of a score < 5 was 85.9%.Delirium incidence (27.0%) was not significantly different compared to 2007 (27.8%) 2006 (23.9%) and 2005 (29.0%) prior to implementation of the RD- protocol.Logistic regression analysis showed that high-risk patients did have a significant higher delirium incidence (42.2% vs. 14.1%, OR 4.1, CI 2.43-7.02). They were more likely to be residing at an alternative living situation after 3 months (62.3% vs. 17.0%, OR 6.57, CI 3.23-13.37) and less likely to be discharged from hospital before 10 days (34.9% vs. 55.9%, OR 1.63, CI 1.03-2.59). Significant independent risk factors for a delirium were a RD-score ≥ 5 (OR 4.13, CI 2.43-7.02), male gender (OR 1.93, CI 0.99-1.07) and age (OR 1.03, CI 0.99-1.07).
  
  
  CONCLUSIONS
  Introducing the delirium prevention protocol did not reduce delirium incidence.The RD-score did identify patients with a high risk to develop a delirium. This high-risk group had a longer LOS and returned to pre-fracture living situation less often.The NPV of a score < 5 was high, as it should be for a screening instrument. Concluding, the RD-score is a useful tool to identify patients with poorer outcome.
authors.affiliation: Department of Orthopaedics, Reinier de Graaf Group, Delft, The Netherlands. ajhvochteloo@hotmail.com
authors.forename: Anne J H
authors.initials: AJ
authors.lastname: Vochteloo
authors.forename: Sophie
authors.initials: S
authors.lastname: Moerman
authors.forename: Boudewijn L S Borger
authors.initials: BL
authors.lastname: van der Burg
authors.forename: Maarten
authors.initials: M
authors.lastname: de Boo
authors.forename: Mark R
authors.initials: MR
authors.lastname: de Vries
authors.forename: Dieu-Donné
authors.initials: DD
authors.lastname: Niesten
authors.forename: Wim E
authors.initials: WE
authors.lastname: Tuinebreijer
authors.forename: Rob G H H
authors.initials: RG
authors.lastname: Nelissen
authors.forename: Peter
authors.initials: P
authors.lastname: Pilot
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003693:Delirium / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006220:Haloperidol / Q000008:administration & dosage*; D006620:Hip Fractures / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D006220:Haloperidol