Glenn Larsson1, Ulf Strömberg2, Cecilia Rogmark3, Anna Nilsdotter4. 1. Department of Ambulance and Prehospital Care, Region Halland, Sweden; Department of Orthopaedics, Lund University, Sweden. Electronic address: Glenn.larsson@regionhalland.se. 2. Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden. 3. Department of Orthopaedics, Lund University, Sweden; Skane University Hospital, Malmö, Sweden. 4. Department of Orthopaedics, Lund University, Sweden; Department of R&D, Sahlgrenska University Hospital, Göteborg, Sweden.
Abstract
INTRODUCTION: Early assessment of hip fracture patients' cognitive function is important for preventing pre- and postoperative complications. The aim of this study was twofold: (1) to assess prehospital cognitive function in hip fracture patients and establish whether cognitive status differs pre- and postoperatively between prehospital fast track care (PFTC) and the traditional emergency department (ED) pathway and (2) whether preoperative cognitive function is associated with postoperative mortality and activities of daily living (ADL) ability. METHODS: Three hundred and ninety one hip fracture patients were prospectively included. The Short Portable Mental Status Questionnaire (SPMSQ) was used prehospital, at the orthopaedic ward and three days postoperatively. ADL was followed up after four months. RESULTS: No difference in patients' cognitive function was observed between PFTC and ED. Four-month mortality was 37% for patients with dementia, 21% for those with cognitive impairment and 10% for patients without cognitive impariment. Only 26% of patients with dementia and 47% with cognitive impairment had full ADL ability, compared with 70% of patients with intact cognitive function (p < 0.001). CONCLUSION: PFTC did not influence hip fracture patients' cognitive function. Patients with prehospital cognitive impairment had a poor outcome in terms of mortality and ADL, indicating the need for special care interventions.
INTRODUCTION: Early assessment of hip fracturepatients' cognitive function is important for preventing pre- and postoperative complications. The aim of this study was twofold: (1) to assess prehospital cognitive function in hip fracturepatients and establish whether cognitive status differs pre- and postoperatively between prehospital fast track care (PFTC) and the traditional emergency department (ED) pathway and (2) whether preoperative cognitive function is associated with postoperative mortality and activities of daily living (ADL) ability. METHODS: Three hundred and ninety one hip fracturepatients were prospectively included. The Short Portable Mental Status Questionnaire (SPMSQ) was used prehospital, at the orthopaedic ward and three days postoperatively. ADL was followed up after four months. RESULTS: No difference in patients' cognitive function was observed between PFTC and ED. Four-month mortality was 37% for patients with dementia, 21% for those with cognitive impairment and 10% for patients without cognitive impariment. Only 26% of patients with dementia and 47% with cognitive impairment had full ADL ability, compared with 70% of patients with intact cognitive function (p < 0.001). CONCLUSION:PFTC did not influence hip fracturepatients' cognitive function. Patients with prehospital cognitive impairment had a poor outcome in terms of mortality and ADL, indicating the need for special care interventions.