Geriatric consultation for delirium (Marcantonio)

Reducing delirium after hip fracture: a randomized trial.

Marcantonio ER, Flacker JM, Wright RJ, et al. Journal of the American Geriatrics Society 2001 · PMID 11380742 · doi:10.1046/j.1532-5415.2001.49108.x

Question

Does proactive geriatric consultation reduce delirium in older patients after hip fracture surgery?

Design

Single-centre randomised controlled trial in a US academic hospital.

Patients

Older patients admitted for surgical repair of hip fracture.

Intervention

Proactive geriatric consultation with structured, protocol-based recommendations

Comparison

Usual care with reactive consultation

Primary outcome

Incidence of delirium during admission

Key result

Proactive geriatric consultation significantly reduced the incidence of delirium (about one third vs one half) and reduced severe delirium by a greater margin.

Limitations

Single centre with a modest sample; no significant effect on length of stay.

Impact on practice

A foundational trial supporting orthogeriatric co-management of hip fracture patients, now embedded in UK practice through NICE hip fracture guidance and the National Hip Fracture Database.