title: Abnormal Mini-Cog Is Associated with Higher Risk of Complications and Delirium in Geriatric Patients with Fracture.
abstract: BACKGROUND
  The Mini-Cog test is a validated and simple tool to screen for dementia. The purpose of this study was to investigate the relationship of cognitive impairment as measured by Mini-Cog testing as a predictor for in-hospital complications and mortality in geriatric patients with fracture.
  
  
  METHODS
  From 2011 to 2014, patients who were seventy years of age or older, had a fracture, and were admitted to co-managed orthopaedic trauma and geriatrics services embedded at two Level-I trauma centers were enrolled in our study. As part of the patients' routine admission evaluation, the Mini-Cog examination was performed. An observational cohort study was completed documenting pre-injury functional status, in-hospital complications, length of stay, thirty-day readmission, and mortality. All patients in the study were followed for at least one year.
  
  
  RESULTS
  Seven hundred and thirty-nine patients (median age, eighty-three years) attempted Mini-Cog testing. Of those, 513 were able to complete the test, demonstrating a 35.1% prevalence of cognitive impairment. The cohort's rate of in-hospital medical complications was 28.6%. Patients with an abnormal Mini-Cog test or those unable to complete the test had significantly higher odds of in-hospital complications (2.16 and 2.27, respectively) compared with patients with a normal Mini-Cog test (p < 0.001). Delirium was significantly increased in patients with an abnormal Mini-Cog test (odds ratio, 3.22; p = 0.001). The all-cause, one-year mortality rate after fracture in our population was 18.1%. Adjusted for age, sex, comorbidity, and fracture type, only the patients unable to complete the Mini-Cog test showed a higher risk of mortality at one year (hazard ratio, 2.26; p < 0.001).
  
  
  CONCLUSIONS
  The Mini-Cog examination is a quick, easily administered screening test for cognitive impairment that is useful in identifying high-risk geriatric patients with fracture. With this tool, we found more than one-third of our elderly patients with fracture were cognitively impaired at the time of admission. These patients had higher rates of in-hospital complications and a trend toward early mortality.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Heng
authors.affiliation: Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Caitlin E
authors.initials: CE
authors.lastname: Eagen
authors.affiliation: Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts hjavedan@partners.org.
authors.forename: Houman
authors.initials: H
authors.lastname: Javedan
authors.affiliation: University of New England College of Osteopathic Medicine, Biddeford, Maine.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kodela
authors.affiliation: Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Weaver
authors.affiliation: Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications / Q000175:diagnosis*; D003693:Delirium / Q000150:complications / Q000175:diagnosis*; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors