Risk of Postoperative Delirium and the Delirium Elderly At Risk (DEAR) Tool - Evidencio
Risk of Postoperative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients
The DEAR score, which relies on baseline information on known delirium risk factors, can be used to identify individuals who are at greatest risk of postoperative delirium.
Research authors: Freter S, Dunbar M, MacLeod H, Morrison M, MacKnight C, and Rockwood K
Version: 1.17
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Total DEAR score: points

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Result interpretation:
In the orignal study by Freter et al. (2005)1 based on 132 elective arthroplasty patients, postoperative delirium occurred in 18 patients (incidence 13.6%). Among arthroplasty patients, having two or more risk factors was associated with an eight-fold increase in the incidence of delirium (chi-square = 6.33, P = 0.01) and with an increased length of stay (9.3 days versus 6.7 days; t = 2.18, P = 0.031).

Overall model performance in original study:1
ROC analysis gave an area under the curve (AUC) of 0.77 (95% CI = 0.64–0.0.87) for the DEAR in predicting delirium. The pre-selected cut-off of two or more risk factors had a sensitivity of 0.61 and a specificity of 0.76. Corresponding negative and positive predictive values were 0.93 and 0.29, respectively.

Overall model performance in validation study:2
In a seperate prospective validation study by Freter et al. (2015) based on 283 patients admitted for surgical repair of hip fracture, the selected cut-off of two or more risk factors had a sensitivity of 0.93 and specificity of 0.68. Corresponding negative and positive predictive values were 0.93 and 0.67, respectively.

References:

  1. Freter S, et al. Predicting post-operative delirium in elective orthopaedic patients: the Delirium Elderly At-Risk (DEAR) instrument. Age Ageing. 2005 Mar;34(2):169-71.
  2. Freter S, et al. Risk of Pre-and Post-Operative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients. Can Geriatr J. 2015; 18(4): 212–216.

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This algorithm is provided for educational, training and information purposes. It must not be used to support medical decision making, or to provide medical or diagnostic services. Read our full disclaimer.

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