Delirium on presentation with a hip fracture is associated with adverse outcomes

Penfold, Rose S., Farrow, Luke, Hall, Andrew J., Clement, Nick D., Ward, Kirsty, Donaldson, Lorraine, Johansen, Antony, Duckworth, Andrew D., Anand, Atul, Hall, Daniel E., Guthrie, Bruce and MacLullich, Alasdair M. J. 2025. Delirium on presentation with a hip fracture is associated with adverse outcomes. The Bone & Joint Journal 107-B (4) , pp. 470-478. 10.1302/0301-620x.107b4.bjj-2024-1164.r1

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Abstract

AimsDelirium is common in hip fracture patients, but large-scale routine data studies examining the prevalence and associations of delirium at the time of initial presentation with a hip fracture are rare. This study aimed to describe the prevalence and outcomes of delirium on initial presentation with a hip fracture in a large national population sample.MethodsThis study analyzed routinely collected national clinical registry data for all people in Scotland aged 50 years and over presenting with a hip fracture between 1 July 2019 and 31 December 2021. Delirium was assessed prospectively by clinicians as part of routine care using the 4AT, a validated two-minute assessment tool. Associations of 4AT score with mortality and return home within 30 days were analyzed using logistic regression models, adjusted for confounders.ResultsOf 18,040 patients (mean age 80 years (SD 10); 70% female (n = 12,594)), 16,476 (91%) had a 4AT assessment on presentation and of these, 3,386 (21%) had a score ≥ 4, suggestive of delirium. Patients with delirium were older, more likely residing in care homes, and had higher American Society of Anesthesiologists grades (all p < 0.001). Delirium was independently associated with a twofold increased risk of inpatient mortality (adjusted odds ratio (aOR) 2.26 (95% CI 1.79 to 2.84)) and one-year mortality (aOR 2.05 (95% CI 1.83 to 2.29)), and a lower likelihood of returning home within 30 days (aOR 0.27 (95% CI 0.24 to 0.30)).ConclusionDelirium affects around 20% of patients presenting with a hip fracture, and is associated with important adverse outcomes. Integrating delirium assessment into the initial clinical assessment of hip fracture patients is feasible at national scale, and should be considered as part of care for all hip fracture patients.Cite this article: Bone Joint J 2025;107-B(4):470–478.

Item Type:	Article
Date Type:	Published Online
Status:	Published
Schools:	Schools > Medicine
Publisher:	British Editorial Society of Bone and Joint Surgery
ISSN:	2049-4394
Last Modified:	14 Apr 2025 09:45
URI:	https://orca.cardiff.ac.uk/id/eprint/177635

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