Associations of 4AT with mobility, length of stay and mortality in hospital and discharge destination among patients admitted with hip fractures

Abstract

Background the 4AT (Alertness, Abbreviated Mental Test-4, Attention and Acute change or fluctuating course), a tool to screen cognitive impairment and delirium, has recently been recommended by the Scottish Intercollegiate Guidelines Network. We examined its ability to predict health outcomes among patients admitted with hip fractures to a single hospital between January 2018 and June 2019. Methods the 4AT was performed within 1 day after hip surgery. A 4AT score of 0 means unlikely delirium or severe cognitive impairment (reference group); a score of 1–3 suggests possible chronic cognitive impairment, without excluding possibility of delirium; a score ≥ 4 suggests delirium with or without chronic cognitive impairment. Logistic regression, adjusted for: age; sex; nutritional status; co-morbidities; polypharmacy; and anticholinergic burden, used the 4AT to predict mobility, length of stay (LOS), mortality and discharge destination, compared with the reference group. Results from 537 (392 women, 145 men: mean = 83.7 ± standard deviation [SD] = 8.8 years) consecutive patients, 522 completed the 4AT; 132 (25%) had prolonged LOS (>2 weeks) and 36 (6.8%) died in hospital. Risk of failure to mobilise within 1 day of surgery was increased with a 4AT score ≥ 4 (OR = 2.4, 95% confidence interval [CI] = 1.3–4.3). Prolonged LOS was increased with 4AT scores of 1–3 (OR = 2.4, 95%CI = 1.4–4.1) or ≥4 (OR = 3.1, 95%CI = 1.9–6.7). In-patient mortality was increased with a 4AT score ≥ 4 (OR = 3.1, 95%CI = 1.2–8.2) but not with a 4AT score of 1–3. Change of residence on discharge was increased with a 4AT score ≥ 4 (OR = 3.1, 95%CI = 1.4–6.8). These associations persisted after excluding patients with dementia. 4AT score = 1–3 and ≥ 4 associated with increased LOS by 3 and 6 days, respectively. Conclusions for older adults with hip fracture, the 4AT independently predicts immobility, prolonged LOS, death in hospital and change in residence on discharge.

Prevalence and consequences of malnutrition and malnourishment in older individuals admitted to hospital with a hip fracture

“…where Z is the level of confidence (we chose Z = 1.96 for 95% CI), P is the expected prevalence (P for risk of malnutrition/malnourishment = 30% based on study by Lisk et al [18]), and d is precision (selected at 0.04, approximately 15% of P which is within the recommended precision of 10-20%) [23].…”

“…Data were prospectively collected by a Trauma Coordinator for patients admitted with a hip fracture through our participation in the National Hip Fracture Database (NHFD) Audit Programme [17][18][19][20]. Information on clinical characteristics and care quality from the time of admission to discharge was documented including: age; sex; residency prior to admission; nutritional status on admission; mobility within 1-day after hip surgery; abbreviated mental test score (AMTS); pressure ulcers; LOS and mortality in hospital; new treatment with an antiresorptive agent and discharge destination.…”

LACE index predicts age-specific unplanned readmissions and mortality after hospital discharge

“…Healthcare services are continually overstretched due to increasing demand, primarily from an expanding ageing population living with multiple chronic conditions and disabilities [1][2][3]. Many such individuals have frequent early hospital readmissions [4] and prolonged length of stay in hospital [5,6], imposing a high pressure on healthcare systems [7,8].…”

Clinical outcomes in patients admitted to hospital with cervical spine fractures or with hip fractures

“…Data were prospectively collected by a Trauma Coordinator for patients admitted with a hip or cervical fracture from the time of admission to discharge [17][18][19]. Co-morbidities were identified from electronic record databases by disease codes defined by the International Classification of Diseases 10 [20].…”