Objective: The primary objective was to identify risk factors independently associated with acute in-hospital delirium within 72 hours of emergency department (ED) arrival for patients diagnosed with a hip fracture.
Methods: This was a retrospective chart review of patients ages 65 years and older presenting to one of two academic EDs with a discharge diagnosis of a hip fracture from January 1, 2014, to December 31, 2015. A multivariable logistic regression analysis was used to determine variables independently associated with the development of acute in-hospital delirium within 72 hours of ED arrival.
Results: Of the 668 included patients, 181 (27.1%) developed delirium within 72 hours of ED arrival. History of neurodegenerative disease or dementia (odds ratio [OR]: 5.7, 95% confidence interval [CI]: 3.9, 8.4), age > 75 (OR: 2.8, 95% CI: 1.4, 5.6), and absence of analgesia (no opioid or nerve block) in the ED (OR: 2.1, 95% CI: 1.3, 3.2) were independently associated with the development of acute in-hospital delirium; 525 (78.6%) patients received opioid analgesia in the ED. The most common analgesics used in the ED were intravenous (IV) morphine (35.8%), IV hydromorphone (35.2%), or dual therapy with both IV hydromorphone and IV morphine (2.2%). Femoral nerve blocks were initiated for 36 (5.4%) patients and successfully completed in 35 (5.2%) patients in the ED.
Conclusions: Advanced age and signs of dementia or neurodegenerative disease are predictors of 72-hour delirium that can be screened for during triage. Improved pain control in the ED may reduce the risk of acute in-hospital delirium.
Keywords: analgesia; delirium; emergency department; hip fracture.