To The Editor:
In their recent paper on the influence of cognitive function on
outcome after hip fracture, Soderqvist et al.(1)stated that cognitive impairment, especially severe
(Short Portable Mental State Questionnaire score <3), is a strong
predictor of poor outcome.
In our own prospective observational study (PolHipQoL study)
evaluating 153 patients for a mean duratlion of 14 months, any kind of
cognitive dysfunction, i.e. mild, moderate or severe ( <8
points), was associated with increased mortality (49.2 vs 14.1%)(2).
Instead of the Short Portable Mental State Questionnaire, we used the
Abbreviated Mental State Questionnaire (AMTS), an instrument recommended for use in the
Standardised Audit of Hip Fracture in Europe (SAHFE)(3). Both
questionnaires are validated, and consist of 10-items that are similar in terms of content,
administration, and scoring(4).
Our study confirmed that cognitive impairment is the
strongest prognostic factor of increased mortality (HR = 3.49; 95%CI: 1.92
– 6.36), better than age over 82 years old (HR = 2.13; 95%CI: 1.32
– 3.42), physical status III or IV in American Society of
Anaesthesiologists ASA scale (HR = 1.95; 95%CI: 1.10 – 3.43) or
anaemia (HR = 1.68; 95%CI: 1.07 – 2.62).
We fully agree with the authors' conclusions that identification of
cognitive dysfunction using a validated instrument, at the time of admission
to the orthopaedic ward, should be considered a mandatory assessment for patients with hip
fracture.
The author(s) of this letter to the editor did not receive payment or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the author(s) are affiliated or associated.
References:
1. Soderqvist A, Miedel R, Pozer S, Tidermark J. The influence of
cognitive function on outcome after a hip fracture. J Bone Joint Surg Am.
2006;88:2115-23.
2. Golicki D, Sliwka A, Fijewski G, Latek M. Quality of life
according to EQ-5D after osteoporotic hip fracture in Poland. Value
Health. 2006;9(6):A382.
3. Standardised Audit of Hip Fracture in Europe (SAHFE).
http://www.sahfe.ort.lu.se/
4. Hodkinson HM. Evaluation of a mental test score for assessment of
mental impairment in the elderly. Age Ageing 1981;1:233-8.
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