Kalisvaart et al identified risk factors associated with postoperative delirium in elderly patients undergoing hip surgery. The authors are from Medical Center Alkmaar, University of Amsterdam and the Free University of Amsterdam, The Netherlands.
Patient selection: hip surgery in a patient >= 70 years of age
Parameters:
(1) mini-mental status examination (MMSE, see 18.03.01)
(2) Acute Physiologic and Chronic Health Evaluation (APACHE) II score (see 30.04), presumably before surgery
(3) binocular near vision
(4) serum blood urea nitrogen to creatinine ratio (see 14.12.01)
ratio of BUN to creatinine =
= (serum BUN in mg/dL) / (serum creatinine in mg/dL)
Parameter
Finding
Points
MMSE
24 to 30
0
0 to 23
1
APACHE II
<= 16
0
> 16
1
vision
20/70 or better
0
worse than 20/70
1
ratio of BUN to creatinine
< 18
0
>= 18
where:
• An APACHE II score > 16 indicates severe illness.
total risk score =
= SUM(points for all 4 risk factors)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the score the greater the risk of delirium.
Total Score
Risk Group
Percent Delirium
0
low
3 - 4%
1 or 2
intermediate
11 - 16%
3 or 4
high
32 - 37%
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