Developing a predictive tool for post-operative delirium in orthopaedic settings in Hong Kong

摘要

Aims: A prospective study was conducted to develop a Common Risk-factor Assessment Predictive Tool (CAP) for identifying factors associated with post-operative delirium (POD) in orthopaedic surgery. A high, moderate and low risk score system was developed. The incidence rate of POD was also determined.Background: POD has been reported as contributing to complications and poor outcomes, consequently affecting recovery and health-care provision.Methods: Thirteen risk factors were evaluated. Regression coefficient and odds ratios were used to determine the association of the risk factors with POD. These were then used to develop a tool. Validation of these associated risk factors was carried out to check their effectiveness in predicting the development of POD.Findings: Fifty nine of 277 patients developed POD. Four major risk factors were identified: visual impairment (p = 0.011; scored as 2), cognitive impairment (p < 0.001; scored as 4), urinary tract or respiratory tract infection (p = 0.028; scored as 3) and use of urinary catheterisation (p = 0.046; scored as 3). Using a 12-point score system the cut-off values were 4.5 (61.0% sensitivity and 85.8% specificity) and 7 (11.9% sensitivity and 95% specificity) respectively.Conclusion: The tool can predict different levels of risk for POD. Nurses can use the tool to communicate patients' risk of POD and identify potential preventive strategies.