ASSESSING PREDICTIVE ABILITY OF A PREOPERATIVE SCREEN TO IDENTIFY OLDER ADULTS AT RISK FOR DELIRIUM FOLLOWING ELECTIVE ORTHOPEDIC SURGERY

A. Vanderbilt, A. Kumar, L. Capone, B. Messinger-Rapport
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Abstract

Objective: Post-surgical nursing interventions can reduce but not eliminate the risk of delirium. A preoperative screen for delirium risk which discriminates between those persons at lower versus higher risk of delirium may help future research efforts develop a subject pool for intensive interventions to reduce delirium incidence. The aim of this study is to assess the ability of a previously developed and tested delirium screening tool, the Cleveland Clinic Confusion Score (CCCS), to predict delirium in a select population. Design: Prospective, observational study. Setting/Participants: Convenience sample of 111 adults aged 50 years or older presenting to a preoperative orthopedic clinic. Intervention: We integrated the CCCS into the preoperative evaluation for elective hip and knee surgery. Postoperatively, clinical care nurses screened patients for delirium twice daily using the Nursing Delirium Screening Scale (Nu-DESC). Research nurses gathered additional data regarding postoperative confusion from the chart and family after discharge. Measurements: Primary outcome was the predictive value of the CCCS for delirium. Results: Of the 111 subjects, a positive preoperative CCCS screen was recorded in 31 individuals (27.9%) and postoperative delirium was identified in 12 individuals (10.8%). CCCS assessment in this population had a positive predictive value of 29% and a negative predictive value of 96%. Conclusion: When a delirium screening tool is incorporated into the preoperative process and coupled with a nursing tool for delirium detection, clinicians can identify a subset of older elective orthopedic surgery patients unlikely to develop postoperative delirium. Preoperative delirium screening may help clinicians focus perioperative interventions on higher risk individuals to further reduce delirium risk beyond current, postoperative nursing interventions.
评估术前筛查对选择性骨科手术后谵妄风险的预测能力
目的:术后护理干预可降低但不能消除谵妄的发生风险。术前筛查谵妄风险,区分谵妄风险较低和较高的人群,可能有助于未来的研究工作开发一个集中干预的对象库,以减少谵妄的发生率。本研究的目的是评估先前开发和测试的谵妄筛查工具,克利夫兰诊所混淆评分(CCCS),在选定人群中预测谵妄的能力。设计:前瞻性观察性研究。背景/参与者:方便样本为111名50岁或以上的成年人,在术前骨科诊所就诊。干预:我们将CCCS纳入择期髋关节和膝关节手术的术前评估。术后,临床护理护士使用护理谵妄筛查量表(Nu-DESC)对患者进行谵妄筛查,每日两次。研究护士从出院后的图表和家属中收集了关于术后混淆的额外数据。测量:主要结果是CCCS对谵妄的预测价值。结果:111例患者中,术前CCCS筛查阳性31例(27.9%),术后谵妄12例(10.8%)。该人群CCCS评估阳性预测值为29%,阴性预测值为96%。结论:当谵妄筛查工具纳入术前流程并结合谵妄检测的护理工具时,临床医生可以识别出不太可能发生术后谵妄的老年择期骨科手术患者子集。术前谵妄筛查可以帮助临床医生将围手术期干预重点放在高危个体上,以进一步降低谵妄风险,超越当前的术后护理干预。
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