Abnormal Mini-Cog Is Associated with Higher Risk of Complications and Delirium in Geriatric Patients with Fracture.

Autor:	Heng M; Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts., Eagen CE; Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts., Javedan H; Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts hjavedan@partners.org., Kodela J; University of New England College of Osteopathic Medicine, Biddeford, Maine., Weaver MJ; Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts., Harris MB; Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	The Journal of bone and joint surgery. American volume [J Bone Joint Surg Am] 2016 May 04; Vol. 98 (9), pp. 742-50.
DOI:	10.2106/JBJS.15.00859
Abstrakt:	Background: The Mini-Cog test is a validated and simple tool to screen for dementia. The purpose of this study was to investigate the relationship of cognitive impairment as measured by Mini-Cog testing as a predictor for in-hospital complications and mortality in geriatric patients with fracture. Methods: From 2011 to 2014, patients who were seventy years of age or older, had a fracture, and were admitted to co-managed orthopaedic trauma and geriatrics services embedded at two Level-I trauma centers were enrolled in our study. As part of the patients' routine admission evaluation, the Mini-Cog examination was performed. An observational cohort study was completed documenting pre-injury functional status, in-hospital complications, length of stay, thirty-day readmission, and mortality. All patients in the study were followed for at least one year. Results: Seven hundred and thirty-nine patients (median age, eighty-three years) attempted Mini-Cog testing. Of those, 513 were able to complete the test, demonstrating a 35.1% prevalence of cognitive impairment. The cohort's rate of in-hospital medical complications was 28.6%. Patients with an abnormal Mini-Cog test or those unable to complete the test had significantly higher odds of in-hospital complications (2.16 and 2.27, respectively) compared with patients with a normal Mini-Cog test (p < 0.001). Delirium was significantly increased in patients with an abnormal Mini-Cog test (odds ratio, 3.22; p = 0.001). The all-cause, one-year mortality rate after fracture in our population was 18.1%. Adjusted for age, sex, comorbidity, and fracture type, only the patients unable to complete the Mini-Cog test showed a higher risk of mortality at one year (hazard ratio, 2.26; p < 0.001). Conclusions: The Mini-Cog examination is a quick, easily administered screening test for cognitive impairment that is useful in identifying high-risk geriatric patients with fracture. With this tool, we found more than one-third of our elderly patients with fracture were cognitively impaired at the time of admission. These patients had higher rates of in-hospital complications and a trend toward early mortality. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. (Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.)
Databáze:	MEDLINE
Externí odkaz: