Delirium and cognitive assessment in national hip fracture registries: a scoping review

Purpose
Delirium and cognitive impairment are common in older adults with hip fracture and are associated with adverse patient outcomes. The Fragility Fracture Network recommends that national hip fracture registries (HFRs) include a measure of cognitive status. However, inconsistency in recording of delirium and cognitive assessment data hinders international comparison and may reduce care quality. This scoping review aims to identify delirium and cognitive assessment data items collected by national HFRs and the associated key data reported in the latest annual reports.

Methods
We searched three databases (Medline Ovid; Embase; CINAHL EBSCOHost) from inception to 18 November 2024 and relevant organisational websites. Two authors independently assessed titles, abstracts, and full texts for eligibility. Prespecified data items were extracted from identified eligible HFRs. Descriptive analysis was used to summarise findings.

Results
Twenty-two eligible HFRs were identified. Of these, 14 (64%) collected delirium assessment data, 18 (82%) collected cognitive assessment data, while only one registry collected neither. There was heterogeneity in delirium and cognitive assessment tools, though seven (50%) HFRs recommended using the 4AT. Delirium assessment completion rates were 47.7–95.9% pre-operatively and 34.2–95.9% post-operatively, while positive delirium score rates were 14.7–22% pre-operatively and 5–42% post-operatively. Cognitive assessment tool completion and positive score rates were 58.5–100% and 9.9–52.4%, respectively.

Conclusion
Most HFRs incorporate delirium and cognitive assessment data items, but there is heterogeneity in tools and methods. Improving the consistency of data collection across HFRs can improve comparability and patient care.