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
Details Custom formula Study characteristics Files & References
★★★★
Model author
Model ID
1595
Version
1.17
Revision date
2018-11-02
MeSH terms
  • Delirium
  • Postoperative Care
  • Elderly
  • Risk
  • Risk Factor
  • Hip
  • Model type
    Linear model (Calculation)
    Status
    public
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    Formula
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    Condition Formula

    Additional information

    In the original study performed by Freter et al. (2005), a total of 132 elective arthroplasty patients were studied to identify risk factors for postoperative delirium (POD). The delirium rate in this study was 13.6%, which was considered within the expected range. Logistic regression was used to explore the association between preoperative factors and POD.

    References:
    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.
     

    Study Population

    Total population size: 132
    Males: {{ model.numberOfMales }}
    Females: {{ model.numberOfFemales }}

    Categorical characteristics

    Name Subset / Group Nr. of patients
    Substance use Yes 46
    No 86
    Age <80 years 82
    ≥80 years 50
    Sensory impairment Yes 95
    No 37
    Dependence in ≥1 ADL Yes 19
    No 113
    Cognitive impairment Yes 21
    No 111

    Related files

    Total DEAR score:
    ...
    points

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    Result
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    Total DEAR score: points

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    Outcome stratification

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    Conditional information

    Result interpretation

    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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    Calculations alone should never dictate patient care, and are no substitute for professional judgement. See our full disclaimer.

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