title: Stability of postoperative delirium psychomotor subtypes in individuals with hip fracture.
abstract: OBJECTIVE
  To determine the stability of psychomotor subtypes of delirium over time and identify characteristics associated with delirium psychomotor subtypes in individuals undergoing surgical repair of hip fracture.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  The Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair Cognitive Ancillary Study was conducted at 13 participating sites from 2008 to 2009.
  
  
  METHODS
  Individuals who had undergone surgical repair of hip fracture (N=139).
  
  
  METHODS
  Delirium was assessed up to four times postoperatively using the Confusion Assessment Method (CAM) and the Memorial Delirium Assessment Scale. Psychomotor subtypes of delirium were categorized as hypoactive, hyperactive, mixed, and normal psychomotor activity.
  
  
  RESULTS
  Incidence of postoperative delirium was 41% (n=57). Of 90 CAM-positive (CAM+) observations, 56% were hypoactive, 10% were hyperactive, 21% were mixed, and 14% had normal psychomotor symptoms. Of 26 participants with more than one CAM+ assessment, 50% maintained subtype stability over time. Participants with hypoactive or normal psychomotor symptoms (n=31) were less likely to have chart documentation of delirium than participants with any hyperactive symptoms (n=19) (22% vs 58%, P=.009).
  
  
  CONCLUSIONS
  Psychomotor subtypes of delirium often fluctuate from assessment to assessment, rather than representing fixed categories of delirium. Hypoactive delirium is the most common presentation of delirium but is the least likely to be documented by healthcare providers.
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Albrecht
authors.affiliation: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Marcantonio
authors.affiliation: Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Darren M
authors.initials: DM
authors.lastname: Roffey
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Denise
authors.initials: D
authors.lastname: Orwig
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Jay
authors.initials: J
authors.lastname: Magaziner
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Michael
authors.initials: M
authors.lastname: Terrin
authors.affiliation: Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, New Brunswick, New Jersey.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Carson
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Erik
authors.initials: E
authors.lastname: Barr
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Jessica P
authors.initials: JP
authors.lastname: Brown
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Emma G
authors.initials: EG
authors.lastname: Gentry
authors.affiliation: Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland.
authors.forename: Ann L
authors.initials: AL
authors.lastname: Gruber-Baldini
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003693:Delirium / Q000145:classification* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification* / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D011595:Psychomotor Agitation / Q000209:etiology* / Q000503:physiopathology
keywords: Confusion Assessment Method; Memorial Delirium Assessment Scale; delirium; hip fracture; psychomotor subtypes