title: Delirium outcomes in a randomized trial of blood transfusion thresholds in hospitalized older adults with hip fracture.
abstract: OBJECTIVE
  To determine whether a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery.
  
  
  METHODS
  Ancillary study to a randomized clinical trial.
  
  
  METHODS
  Thirteen hospitals in the United States and Canada.
  
  
  METHODS
  One hundred thirty-nine individuals hospitalized with hip fracture aged 50 and older (mean age 81.5 ± 9.1) with cardiovascular disease or risk factors and hemoglobin concentrations of less than 10 g/dL within 3 days of surgery recruited in an ancillary study of the Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair.
  
  
  METHODS
  Individuals in the liberal treatment group received one unit of packed red blood cells and as much blood as needed to maintain hemoglobin concentrations at greater than 10 g/dL; those in the restrictive treatment group received transfusions if they developed symptoms of anemia or their hemoglobin fell below 8 g/dL.
  
  
  METHODS
  Delirium assessments were performed before randomization and up to three times after randomization. The primary outcome was severity of delirium according to the Memorial Delirium Assessment Scale (MDAS). The secondary outcome was the presence or absence of delirium defined according to the Confusion Assessment Method (CAM).
  
  
  RESULTS
  The liberal group received a median two units of blood and the restrictive group zero units of blood. Hemoglobin concentration on Day 1 after randomization was 1.4 g/dL higher in the liberal group. Treatment groups did not differ significantly at any time point or over time on MDAS delirium severity (P = .28) or CAM delirium presence (P = .83).
  
  
  CONCLUSIONS
  Blood transfusion to maintain hemoglobin concentrations greater than 10 g/dL alone is unlikely to influence delirium severity or rate in individuals with hip fracture after surgery with a hemoglobin concentration less than 10 g/dL.
authors.affiliation: Division of Gerontology, Department of Epidemiology and Public Health, University of Maryland School of Medicine, 660 W. Redwood St., Howard Hall Suite 200, Baltimore, MD 21201, USA. abaldin@epi.umaryland.edu
authors.forename: Ann L
authors.initials: AL
authors.lastname: Gruber-Baldini
authors.forename: Edward
authors.initials: E
authors.lastname: Marcantonio
authors.forename: Denise
authors.initials: D
authors.lastname: Orwig
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
authors.forename: Michael
authors.initials: M
authors.lastname: Terrin
authors.forename: Erik
authors.initials: E
authors.lastname: Barr
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Brown
authors.forename: Barbara
authors.initials: B
authors.lastname: Paris
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Zagorin
authors.forename: Darren M
authors.initials: DM
authors.lastname: Roffey
authors.forename: Khwaja
authors.initials: K
authors.lastname: Zakriya
authors.forename: Mary-Rita
authors.initials: MR
authors.lastname: Blute
authors.forename: J Richard
authors.initials: JR
authors.lastname: Hebel
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion / Q000379:methods*; D003693:Delirium / Q000097:blood* / Q000175:diagnosis / Q000517:prevention & control*; D017707:Erythrocyte Transfusion / Q000379:methods*; D005260:Female; D006452:Hemoglobinometry; D006620:Hip Fractures / Q000097:blood* / Q000601:surgery*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D009483:Neuropsychological Tests; D012307:Risk Factors
keywords: blood transfusion; delirium; hip fracture
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