Fatores preditores de delirium e cognição em idoso com fratura de fêmur: pontos de corte para triagem cognitiva de 10 pontos (CS-10) e Mini-Cog que discriminam idosos com fratura de fêmur

Abstract

Summary: Delirium is a common complication in elderly people undergoing femoral fracture surgery. It is related to greater morbidity, mortality and functional and cognitive decline. Despite its relevance from a clinical, economic and social point of view, interventions to reduce its occurrence and severity remain neglected. Objectives: This study sought to establish cutoff points for the 10-point Cognitive Screening (CS-10) and Mini-Cog in elderly people after femoral fracture surgery and verify the association between cognitive decline and delirium, considering the points established cutoffs. Methods: 51 patients were evaluated in a prospective cohort study, with CS-10 and Mini-Cog tests performed before and after surgery. Delirium was assessed on admission and prospectively by the Confusion Assessment Method (CAM). Results: Analysis of the Receiver operator characteristic curve (ROC) determined cutoff points for CS-10 and Mini-Cog, which could discriminate delirium. Logistic regression reveals that elderly people with Cs-10 ≤5 points and Mini-Cog≤ 2 points were more likely to develop delirium, even after adjusting for sex, age and education. Conclusion: Patient with perioperative Cs-10 ≤5 and Cs-10 ≤5 was more likely to develop delirium. Stratification based on cognitive assessment can guide the implementation of cost effective prophylactic interventions in surgical patients with femoral fractures, aiming to improve clinical results and reduce costs in the healthcare system.