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Delirium Outcomes in a Randomized Trial of Blood Transfusion Thresholds in Hospitalized Older Adults with Hip Fracture
Author(s) -
GruberBaldini Ann L.,
Marcantonio Edward,
Orwig Denise,
Magaziner Jay,
Terrin Michael,
Barr Erik,
Brown Jessica P.,
Paris Barbara,
Zagorin Aleksandra,
Roffey Darren M.,
Zakriya Khwaja,
Blute MaryRita,
Hebel J. Richard,
Carson Jeffrey L.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12396
Subject(s) - medicine , delirium , randomization , hip fracture , randomized controlled trial , anemia , blood transfusion , hemoglobin , clinical endpoint , surgery , intensive care medicine , osteoporosis
Objectives To determine whether a higher blood transfusion threshold would prevent new or worsening delirium symptoms in the hospital after hip fracture surgery. Design Ancillary study to a randomized clinical trial. Setting Thirteen hospitals in the U nited S tates and C anada. Participants One hundred thirty‐nine individuals hospitalized with hip fracture aged 50 and older (mean age 81.5 ± 9.1) with cardiovascular disease or risk factors and hemoglobin concentrations of less than 10 g/dL within 3 days of surgery recruited in an ancillary study of the T ransfusion T rigger T rial for F unctional O utcomes in C ardiovascular P atients U ndergoing S urgical H ip F racture R epair. Intervention Individuals in the liberal treatment group received one unit of packed red blood cells and as much blood as needed to maintain hemoglobin concentrations at greater than 10 g/dL; those in the restrictive treatment group received transfusions if they developed symptoms of anemia or their hemoglobin fell below 8 g/dL. Measurements Delirium assessments were performed before randomization and up to three times after randomization. The primary outcome was severity of delirium according to the M emorial D elirium A ssessment S cale ( MDAS ). The secondary outcome was the presence or absence of delirium defined according to the C onfusion A ssessment M ethod ( CAM ). Results The liberal group received a median two units of blood and the restrictive group zero units of blood. Hemoglobin concentration on Day 1 after randomization was 1.4 g/dL higher in the liberal group. Treatment groups did not differ significantly at any time point or over time on MDAS delirium severity ( P = .28) or CAM delirium presence ( P = .83). Conclusion Blood transfusion to maintain hemoglobin concentrations greater than 10 g/dL alone is unlikely to influence delirium severity or rate in individuals with hip fracture after surgery with a hemoglobin concentration less than 10 g/dL.