Marilyn Heng1, Caitlin E Eagen2, Houman Javedan3, Jennifer Kodela4, Michael J Weaver2, Mitchel B Harris2. 1. Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, Massachusetts. 2. Department of Orthopedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Brigham and Women's Hospital, Boston, Massachusetts. 3. 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. 4. University of New England College of Osteopathic Medicine, Biddeford, Maine.
Abstract
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.
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.
Authors: Ali Shami; Maura Brennan; Peter St Marie; Peter K Lindenauer; Mihaela S Stefan Journal: Arch Gerontol Geriatr Date: 2019-07-18 Impact factor: 3.250
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Authors: Victor X Fu; Johannes Jeekel; Esther M M Van Lieshout; Detlef Van der Velde; Leonie J P Slegers; Robert Haverlag; Johan Haumann; Marten J Poley; Michael H J Verhofstad Journal: BMJ Open Date: 2021-12-23 Impact factor: 2.692