Abstract Details

Title The Clock Drawing Test as a Predictor of Postoperative Delirium After Urgent Hip Fracture Surgery

Topic Aging, Dementia, and Behavioral Neurology

Presentation(s) P7 - Poster Session 7 (8:00 AM-9:00 AM)

Poster/Presentation
Number 7-004

Objective To assess how preoperative clock drawing to command and copy conditions may identify delirium risk in patients undergoing urgent hip fracture surgery.

Background Although the American College of Surgery guidelines for geriatric patients recommends preoperative cognitive screening, this has not been routinely applied to one of the highest delirium risk groups: older adults undergoing urgent hip fracture surgery. Clock drawing to copy was recently identified as an important predictor for postoperative length of stay and cost, but its value relative to command performance and delirium prediction warrants investigation.

Design/Methods Within a hospital learning study with a multidisciplinary team, post-injury, pre-operative hip fracture patients were screened with a brief cognitive assessment including the digital clock drawing test to command and copy, and a baseline CAM-ICU. Participants were followed postoperatively twice daily for development of delirium using the CAM-ICU. Traditional visual scale components of the clocks (3 item score for command/copy) were calculated by trained raters and differences from command to copy performance were calculated.

Results 30 individuals consented, with two excluded due to preoperative delirium. Final sample (n = 24; age 83.83 ± 8.83; education= 13.08 ± 2.96; 83% female). 4 (17%) of participants were POD positive (PODp) vs 20 (83%) POD negative (PODn). Groups did not differ significantly in age, education or sex. POD groups were different in preoperative dCDT copy (PODp = 0.75 ± 0.96, PODn = 2.20 ± 0.96, t(22)=2.80, p<.05) but not command conditions. All PODp failed to either improve from command to copy or produce a “correct” (3/3 score) clock, relative to 35% of PODn (χ²(1)=5.67, p<.02).

Conclusions Data suggest potential sensitivity for POD prediction when both command and copy clock drawings are incorporated into preoperative cognitive assessments. Future research needs to study the subtle behavioral features of command and copy clock drawing in a larger sample of at-risk patients.

Authors/Disclosures
Benjamin Chapin, MD (UF) PRESENTER	Dr. Chapin has nothing to disclose.
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file

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