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Approach to the risk of delirium in an orthogeriatric unit
Abordaje del riesgo de delirium en una unidad de ortogeriatría
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The target population is patients 65 and older<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">4</span></a> with a diagnosis of a femur fracture. The comprehensive geriatric assessment at admission to the acute care hospital characterises these units. This assessment establishes preventive and therapeutic measures for complications secondary to surgery, with special focus on the prevention and active treatment of possible geriatric syndromes that may appear during hospitalisation,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">5,6</span></a> such as delirium, constipation, urinary infections and pressure ulcers. Rehabilitation therapy, as well as cognitive stimulation and nutritional support during convalescence are also included in the orthogeriatric care process.</p><p id="par0010" class="elsevierStylePara elsevierViewall">One especially significant geriatric syndrome that patients with fractured femur may present is delirium; it is important because of its severity and high incidence, occurring in a significant percentage of cases.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">7</span></a> According to the literature, between 25% and 50% of all patients (40–50% if including prior cognitive impairment) will present an episode of delirium after surgery for a fractured femur.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Patients with a previous diagnosis of dementia or a history of delirium during at least one previous admission are considered to be at higher risk of delirium.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">8</span></a> Given the impact of this complication on the quality of life and the subsequent evolution of the patient, its early detection and active prevention in high-risk patients is of the utmost importance. On this basis, we believe that carrying out a study to try to reduce the incidence of this complication is fully justified. For all the above, the purpose of this study is to evaluate the efficacy of optimising the therapeutic regimen to reduce the incidence rate of delirium during the period after a femur fracture operation, in geriatric patients. This study has specifically tried to investigate the efficacy of a set of pharmacological and non-pharmacological measures, and a prophylactic treatment regime for delirium in this group of high-risk patients. The study's hypothesis is that this global optimisation strategy will reduce the incidences of delirium occurring in patients admitted to our orthogeriatric unit, aged 70 or older, with a femur fracture. It seems logical to assume that this strategy will be effective. However, up to now, this has not been clearly proven or demonstrated, justifying this study.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients</span><p id="par0015" class="elsevierStylePara elsevierViewall">The subjects included in the study were patients from the orthogeriatric unit in our centre. Admission criteria to the unit were: patients undergoing femur fracture surgery, aged 70 or older. Exclusion criteria were: periprosthetic fractures, fractures of metastatic origin and patients with fractures other than femur fracture, such as ischiopubic branch fracture. The unit's protocol admits patients to the acute care hospital for a physical and functional evaluation (previous and current Barthel), cognitive assessment (Pfeiffer) and social analysis by the orthogeriatric team that comprises a doctor, a nurse and a social worker, who travel to that hospital. The patient is also monitored daily by the trauma team, for the detection and prevention of possible geriatric syndromes and complications during admission. This procedure facilitates an active preventive treatment of high-risk patients. On the fifth day of surgery, the patient is admitted to the Sociosanitary hospital for convalescence and remains there until hospital discharge. These two hospital centres are independent and even belong to different health providers, but their close location allows us to easily travel between both for the initial assessment and daily monitoring of the patient.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Design and treatment</span><p id="par0020" class="elsevierStylePara elsevierViewall">The research project was designed as a prospective, comparative, interventional, nonrandomised study with two patient cohorts. The first cohort were those admitted over the first four months of the study period, received the usual treatment and was considered the control group or cohort. The second cohort were admitted over the following four months and received a different therapeutic strategy; this group was considered the experimental group or cohort. The results obtained in the experimental group were compared with the results from the control group. The study inclusion period was eight months. The patient follow-up period to observe the results was the duration of their hospital admission in the Sociosanitary hospital's orthogeriatric unit. The patients included in the control group received the usual treatment from Traumatology Services, through the prescription of the conventional analgesic regimen. This standard analgesic regimen consisted of administering 1<span class="elsevierStyleHsp" style=""></span>g of paracetamol intravenously alternated with 2<span class="elsevierStyleHsp" style=""></span>g of metamizol intravenously every 6–8<span class="elsevierStyleHsp" style=""></span>h and rescue treatment of 50–100<span class="elsevierStyleHsp" style=""></span>mg of tramadol intravenously every 6–8<span class="elsevierStyleHsp" style=""></span>h. Diazepam was administered if necessary. The patients in the experimental group received an experimental therapeutic strategy: 1<span class="elsevierStyleHsp" style=""></span>g of paracetamol intravenously alternated with 2<span class="elsevierStyleHsp" style=""></span>g of metamizol intravenously every 6–8<span class="elsevierStyleHsp" style=""></span>h and rescue analgesia with 2–4<span class="elsevierStyleHsp" style=""></span>g of subcutaneous morphine every four hours as needed, replacing intravenous tramadol. Short-acting benzodiazepines were given instead of diazepam, if necessary. Furthermore, patients with a high-risk of presenting delirium were identified in the experimental cohort; these patients had either a previous diagnosis of dementia and/or a history of delirium in previous admissions. All of them were given prophylactic treatment for delirium with haloperidol at low doses (5 drops every 8<span class="elsevierStyleHsp" style=""></span>h) or their usual dose of neuroleptic treatment was increased (if they had been previously prescribed it), which was common in patients with dementia. The experimental strategy had a complementary non-pharmacological approach, and was explained to the patient and the family: regulation of the sleep rhythm and techniques facilitating temporo-spatial orientation (which are detailed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). These non-pharmacological measures were based on the results of the HELP<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> study.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">The Confusion Assessment Method scale was applied to detect, diagnose and subsequently monitor delirium. The doctor from the Orthogeriatric Unit performed a follow-up and a daily reassessment of the patient's delirium diagnosis, regardless of the hospital where they were admitted – the acute care hospital or the Sociosanitary Hospital. The Orthogeriatric Unit doctor is the medical doctor at the Sociosanitary Hospital and treats all the patients with femur fractures who are referred from the acute care hospital's Traumatology Department and, therefore, has exceptional knowledge and experience in the management of the geriatric patient.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">The main variable of the study was the percentage of patients who presented an episode of delirium during the period following a femur fracture operation. The main analysis compared the control cohort and experimental cohort delirium incidence rates. To calculate the sample size, we considered that the percentage of patients who would present an episode of delirium in the control cohort would be 38%. It was expected that the percentage of patients presenting an episode in the experimental cohort would be approximately 20%. To find statistically significant differences with alpha and beta errors of 5 and 80%, respectively, a total of 90 patients (95 if we considered the expected losses of 5%) would need to be included. Qualitative variables were expressed as frequencies and percentages. Quantitative variables were expressed by their means, medians and 95% confidence intervals (CI). For the comparison between quantitative variables, the Student–Fisher <span class="elsevierStyleItalic">t</span> test (two variables) or the Mann–Whitney <span class="elsevierStyleItalic">U</span> test was used when verification with the Kolmogorov–Smirnov test showed that the variable did not conform to normal. The association between qualitative variables was determined using the chi-squared test (applying Fisher's exact test for square tables). The statistical analysis was carried out following the ‘Intention to treat’ methodology, such that all patients assigned to a group were included in the analysis. A population ‘per protocol’ analysis was not considered. Determining the predictive factors that would predict the appearance of delirium was carried out by including them in a logistic regression analysis model where the dichotomous dependent variable was ‘delirium during admission’ (yes/no).</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Ethical aspects</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the Joan XXIII Tarragona University Hospital Clinical Research Ethics Committee and each patient – or their relatives and/or legal guardians, in case the patient was unable to decide for themselves – gave their informed consent before starting any procedure. The study was carried out in accordance with standards from the latest version of the Declaration of Helsinki, Fortaleza 2013. The data have been used, and will be used in the future, exclusively for this study and for the objectives mentioned in the protocol.</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">Between March 15, 2016 and November 15, 2016, a total of 88 patients undergoing surgery for femur fracture in the Orthopaedic Surgery and Traumatology Department of the Joan XXIII Tarragona University Hospital were evaluated to be included in the study and subsequently admitted to the Francolí Sociosanitary Hospital Orthogeriatric Unit. We excluded three patients with metastatic femur fracture, who had not been assigned to any study cohort. Thus, the total sample size was 85 evaluable patients (42 patients in the control group and 43 patients in the experimental group). No patient abandoned the study. Patients baseline and demographic characteristics were equally balanced between the two groups, with no statistically significant differences. Sixty-four patients were women (75%). Patients’ mean age was 85 (range 71–105). Eighty patients (94%) were aged 75 or older. A distribution by age segments – with a cut-off point of 75 and 85 – was the same for both groups (chi-squared <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.676 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.078, respectively). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the patients’ demographic baseline characteristics. Of the total sample, 57 patients (67%) had no previous diagnosis of dementia. Among the 22 patients (26%) who had a previous diagnosis of dementia, the most frequent type was Alzheimer's disease, occurring in 12 patients (54%). Sixteen of the total 85 patients (19%) had a history of delirium in a previous hospital admission.</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Regarding the study's main variable, delirium was observed in 29 patients (34%) admitted, out of the total 85 patients included in both groups. Sixteen patients (38%) from the control group (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42) presented delirium and 13 patients (30%) from the experimental group (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>43) presented delirium. This numerical difference shows a trend towards a lower incidence rate in the experimental group, but did not reach statistical significance (chi-squared test <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.489).</p><p id="par0050" class="elsevierStylePara elsevierViewall">The average duration of delirium in the 29 patients who presented it was 5.3 days (range 2–15). The mean duration of delirium in the control group was 6.6 days in the experimental group and 3.8 days, which represents a statistically significant difference (Mann–Whitney <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.031). All patients who presented an episode of delirium lasting more than seven days underwent a cognitive assessment and the study was extended. All had a cognitive impairment due to a possible dementia that had not been previously diagnosed and they were referred at discharge to the Dementia Unit for follow-up and assessment.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In the subgroup of patients who had a history of delirium in a previous admission (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16; six in the control group and 10 in the experimental group), the percentage of delirium during the current admission was lower in the experimental group (two out of 10; 20%) compared to the control group (five out of six; 83%). This difference was statistically significant (chi-squared <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.036). A similar comparison between the experimental and control groups for delirium incidence in the study's admission (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) was not observed in subgroups of patients with prior dementia (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>22; chi-squared <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.666) or those who were older, both for the cut-off point of over 75 (chi-squared <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>0.486) and over 85 (chi-squared <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">=</span><span class="elsevierStyleHsp" style=""></span>0.493).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">The best predictor(s) of the risk of presenting an episode of delirium during the study's admission was/were determined in a multivariate logistic regression analysis. This analysis was carried out in the entire population (<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>85) and included the presence of previous dementia (yes/no), a history of delirium in a previous admission (yes/no) and treatment group (standard/experimental). The results showed that the only factor that had an independent predictive value was a previous history of dementia with a relative risk of 3.12 (95% CI [1.02–9.59]; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.047) (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>).</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Five patients died during the study, with no significant differences between the two groups: one control patient and four from the experimental group (chi-squared <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.360). The patient from the control group who died, aged 85, presented a 15-day delirium. The four patients from the experimental group were aged 105, 95, 90 and 88; two of them did not present delirium and as such had not received treatment with haloperidol and the other two presented delirium during admission, lasting seven and four days, respectively.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">The results of this study show that a change in the therapeutic strategy can significantly decrease the duration and incidence rates of delirium, although the latter was not statistically significant. This therapeutic strategy researched comprises a change in the analgesic regime, applying non-pharmacological measures and prescribing preventive pharmacological treatment in patients who, because of their age and history, are more at risk of presenting an episode of delirium during the period following a femur fracture operation. The preventive and therapeutic strategies received by patients in the experimental group were based on data from previous literature. They include the non-pharmacological measures described in the HELP<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">10</span></a> study and changing the type of benzodiazepines, which was previously described as one of the most important factors predicting the appearance of postoperative delirium in patients with femur fracture.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">11</span></a> The incidences of delirium in the experimental group was 30%, a remarkable result when compared with the best percentages reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">1,3,4,6</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">It is worth noting that a statistically significant difference was observed in the subgroup of patients with a history of delirium (a high-risk factor for presenting another episode), showing a lower incidence of delirium in the experimental group. Specifically, in this group the percentages of 80/20% to 20/80% are inverted in the risk of delirium during admission between the control group and the experimental group. The risk factors that have been shown in the study to be significant in the control group were previous dementia and a history of delirium. However, these factors do not show that predictive capacity in the experimental group, which confirms the effectiveness of the intervention, since it was in these groups, considered high-risk, that the prophylactic pharmacological treatment was administered in the experimental cohort.</p><p id="par0080" class="elsevierStylePara elsevierViewall">We must also refer to the importance of the duration of the episodes of delirium,<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">9</span></a> since this result shows a clear statistically significant difference in favour of the experimental group. The clinical impact of the duration of an episode of delirium is key to the patient's subsequent evolution and the appearance of other complications or geriatric syndromes throughout their admission. The results of this study confirm that the patient's history – specifically a history of dementia and of episodes of delirium in previous admission – is the most significant predictor of the risk of presenting a new episode of delirium. This study also shows that a proactive approach through the application of pharmacological (in these risk groups) and non-pharmacological measures in all patients, has a positive impact on the prevention of delirium during the period following a femur fracture operation. Of the four patients who died in the experimental group, two did not present delirium, so they did not receive treatment with haloperidol; because this figure is so insignificant, the difference cannot be attributed to this drug.</p><p id="par0085" class="elsevierStylePara elsevierViewall">This study has strengths and limitations. Its strong points include that it has been carried out in a specialised orthogeriatric unit, experienced in the clinical management of these patients; it is a prospective study, which facilitates the completeness of the data, and the fact that it is comparative between two cohorts has allowed us to apply inferential statistics methods. One of the study's limitation is that, despite being a comparative study, it is not randomised or blind, so we cannot exclude a bias associated with sequential temporality in the two cohorts or a bias associated with the researchers’ knowledge of the treatment. Another small limitation is that we were unable to reach our pre-specified sample size, and 85 subjects may be considered a small sample size for a comparative study. This does not affect the credibility of the statistically significant results (duration of the episodes of delirium), although it may be a problem when assessing the negative results (incidence of delirium during admission) since it may mean a lack of statistical power to detect existing associations.</p><p id="par0090" class="elsevierStylePara elsevierViewall">With regard to future perspectives, we believe that research and study in the field of delirium prevention during the postoperative period in orthogeriatric units is necessary, as it is a great problem, and, as we have seen in this study, susceptible to change with preventive strategies. In addition, patients with delirium have a higher mortality rate than patients who do not, especially those with prior dementia.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">12</span></a> Regarding the issue of the sample size, we believe that furthering the study and expanding the sample size would be of interest, as it would answer questions about the analyses that did not reach statistical significance. If the results obtained can be confirmed in a larger study, the incorporation of a new standard for the preventive management of delirium in geriatric patients with femur fracture during the postoperative period could be seriously considered.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In conclusion, the experimental treatment resulted in a decrease in the duration of episodes of delirium to almost half. It also resulted in a non-significant, albeit clinically important, reduction in the incidence of delirium in the total sample. In the subgroup of patients with a history of prior delirium, this decrease in incidence was statistically significant. The experimental research conducted for this study has been beneficial for patients, especially for those who had a greater risk of presenting an episode of delirium during the period following their femur fracture operation.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conflict of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1178783" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1100239" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1178784" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1100238" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Patients and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Design and treatment" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical methods" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethical aspects" ] ] ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conflict of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-24" "fechaAceptado" => "2018-06-14" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1100239" "palabras" => array:3 [ 0 => "Delirium" 1 => "Hip fracture" 2 => "Orthogeriatrics" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1100238" "palabras" => array:3 [ 0 => "Delirium" 1 => "Fractura de cadera" 2 => "Ortogeriatría" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this study is to evaluate the efficacy of a change in the management of the risk of delirium in an orthogeriatric unit.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Prospective, comparative, non-randomised study of two cohorts of patients. One cohort (control group) treated with standard therapy with tramadol rescue and diazepam and another cohort (experimental group) treated with rescue with morphine at low doses and short half-life benzodiazepines as well as preventive treatment with neuroleptics in patients at high risk.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Eighty-five patients were included (42 in the control group and 43 in the experimental group). Mean age: 85 (71–105). Twenty-nine patients (34%) had an episode of delirium during the current admission, 16 patients (38%) in the control group and 13 patients (30%) in the experimental group respectively (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.498). The mean duration of delirium in the 29 patients who presented it was 5.3 days. This duration in the control group was 6.6 days and in the experimental group was 3.8 days (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.031). In the group of patients who had previous delirium, a lower incidence of delirium was seen during the current admission in the experimental group (80% vs. 17% <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.036).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Experimental treatment has been effective since a trend to a lower incidence of delirium has been observed. In the patients who have suffered an episode of delirium, the treatment served to decrease its duration with statistically significant differences.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El objetivo de este estudio es evaluar la eficacia de un cambio en la estrategia de manejo del riesgo de delirium en una unidad de ortogeriatría.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo, comparativo, no aleatorizado de 2 cohortes de pacientes. Una cohorte (grupo control) tratado con la terapia estándar con tramadol de rescate y diazepam, y otra cohorte (grupo experimental) tratado con morfina a dosis bajas de rescate junto con benzodiacepinas de vida media corta y tratamiento preventivo con neurolépticos, en los pacientes de alto riesgo.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se ha incluido a 85 pacientes (42 en el grupo control y 43 en el grupo experimental). Edad media: 85 años (71-105). Un total de 29 pacientes (34%) han tenido un episodio de delirium durante el ingreso actual, 16 pacientes (38%) en el grupo control y 13 pacientes (30%) en el grupo experimental, respectivamente (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,498). La duración media del delirium en los 29 pacientes que lo presentaron fue de 5,3 días. Esta duración fue en el grupo control de 6,6 días y en el grupo experimental de 3,8 días, respectivamente (p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,031). En el grupo de pacientes que tenían antecedente de delirium previo, se aprecia que hay una menor incidencia de delirium durante el ingreso actual en el grupo experimental (80% vs. 17%, p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,036).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La terapia experimental ha resultado eficaz, ya que se ha podido observar una tendencia a disminuir la incidencia del delirium y en los casos que lo han presentado la terapia sirvió para disminuir su duración con diferencias estadísticamente significativas.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Please cite this article as: Sopena Bert E, Qanneta R, Valentí Moreno V, San José Laporte A. Abordaje del riesgo de delirium en una unidad de ortogeriatría. Med Clin (Barc). 2019;152:298–302.</p>" ] ] "multimedia" => array:4 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">In addition, non-pharmacological measures were applied to all patients in the experimental group in order to prevent the onset of delirium, based on the results of the HELP study: the patient and the family were informed about the possibility of delirium with the aim of reassuring them; the patient's sleep rhythm was maintained regularly according to a schedule (early wake up in the morning and short nap as needed); temporo-spatial orientation was maintained, and the family were advised to use a clock and calendar, and to reminder the patient that they were hospitalised and why on a daily basis. The use of glasses or hearing aids was recommended to patients who previously used them.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Group \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Analgesia/pharmacological regime \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-pharmacological measures \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">High-risk patient management \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Control \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Analgesia: paracetamol<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>metamizol<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>rescue with tramadol with or without diazepam \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Experimental \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Analgesia: paracetamol<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>metamizol<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>rescue with morphine with or without a short half-life benzodiazepine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Application of non-pharmacological measures \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Preventive pharmacological treatment in high-risk patients \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2008648.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Strategies in the control and experimental groups.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">NS: not significant.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>85 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>42 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Experimental<br><span class="elsevierStyleItalic">N</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>43 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> control vs. experimental \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Sex, n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 (75) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (76) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32 (74) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 (25) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age (years), mean, range</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 (71–105) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">84 (71–96) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">86 (71–105) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Previous diagnosis of dementia, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">22 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 (24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9 (21) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">History of delirium in previous admission, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (19) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6 (14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">10 (23) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Barthel index admission, mean</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Barthel index high, mean</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Charlson index, mean</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.09 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Haemoglobin (g/dl), mean</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12.00 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Urea (mg/dl), mean</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Creatinine (mg/dl), mean</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.97 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.07 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.026<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">c</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Albumin (mg/dl), mean</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2008647.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Chi-squared.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Student–Fisher <span class="elsevierStyleItalic">t</span> test.</p>" ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "c" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Mann–Whitney <span class="elsevierStyleItalic">U</span> test.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Patients’ demographic and clinical characteristics.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">NS: not significant.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Total \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Control \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Experimental \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> control vs. experimental \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleItalic">Global (n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">85)</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">38% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">30% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">62% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">70% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients with previous dementia (n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">22)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">61% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients with previous delirium (n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">16)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">44% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.023<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patients over 75 (n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">80)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">36% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">41% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NS<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Duration of delirium in half days (n</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">=</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">29)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">6.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.031<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">b</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2008645.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Chi-squared.</p>" ] 1 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0025">Mann–Whitney <span class="elsevierStyleItalic">U</span> test.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Efficacy results. Presence of delirium during admission.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Significance \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Exp(B) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Inferior \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Superior \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Previous dementia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.047 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.02 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">9.59 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">History of delirium \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.965 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.03 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.28 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.73 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Study group (control vs. experimental) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.606 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.30 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.01 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Constant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.021 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2008646.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Logistic regression analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:12 [ 0 => array:3 [ "identificador" => "bib0065" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Orthogeriatrics moving forward" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. 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