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length of hospital stay after univariate analysis. Comparing with
patients without anemia and BT as a reference, only patients
who received BT had higher risk to have POD (anemia with BT:
OR: 4.364, 95% CI: 1.580–12.053; without anemia but receiving BT:
OR: 5.139, 95% CI: 1.848–14.294) after controlling confounders.
Moreover, anemia is also not risk factor in both gender, and
only men receiving BT had a significant risk for POD (OR 4.483;
95% CI: 1.266–15.869).
Conclusions:
Among older patients undergoing elective orthopedic
surgery, receiving blood transfusion in operation is a significantly
risk factor for postoperative delirium, not anemia at admission, and
the risk was only found in men, not women.
P-176
Are preoperative cerebrospinal fluid melatonin concentrations
associated with postoperative delirium?
R. Scholtens
1
, S. De Rooij
2
, B. Van Munster
3
, A. Vellekoop
4
,
B. Vrouenraets
5
1
AMC, Amsterdam, Netherlands;
2
UMCG, Groningen, Netherlands;
3
UMCG, Amsterdam, Netherlands;
4
Erasmus Medical Center,
Rotterdam, Netherlands;
5
SLAZ, Amsterdam, Netherlands
Objective:
In delirious patients a disturbed sleep-wake rhythm
is often observed. Melatonin, a hormone produced by the pineal
gland, is a key factor in regulating circadian rhythm. Our aim is to
investigate whether delirium is associated with cerebrospinal fluid
(CSF) melatonin levels.
Methods:
Patients aged ≥65 years, acutely admitted to the hospital
for surgical repair of a hip fracture and received spinal anaesthesia,
were included. CSF was collected during cannulation prior to
surgery. Melatonin was measured by direct radioimmuno assay
(RIA). Patients were screened for delirium daily with the Delirium
Observating Screening Scale (DOSS) by nursing staff. If the DOSS
≥3 a psychiatrist was consulted to confirm the diagnosis using the
DSM-IV criteria.
Results:
Sixty patients were included in the analysis. Thirteen
patients (21.7%) experienced delirium during admission of which
one before surgery. Baseline characteristics did not differ between
delirious and non-delirious patients. In subjects with and without
postoperative delirium mean melatonin levels were 12.91 pg/ml
(SD 6.6 pg/ml) and 11.72 pg/ml (SD 4.5 pg/ml) respectively, p-
value 0.48. No differences in mean melatonin levels were found
between patients who experienced delirium and those who did
not in analyses stratified for factors that could influence melatonin
levels like cognitive impairment, age, use of medication, season,
and part of day of CSF sampling.
Conclusion:
In this study preoperative CSF melatonin levels
aren’t associated with postoperative delirium in older hip fracture
patients. As melatonin was measured before surgery and delirium
usually occurs 2–4 days after surgery this could have influenced
the results.
Ethics and end of life care
P-177
The Sequential Organ Failure Assessment (SOFA) score is a
predictive factor for 14-day mortality of elderly patients with
advanced cancer who present to the ED
H.S. Choi
1
, S.Y. Lee
2
, Y.G. Ko
1
, H.P. Hong
1
, J.S. Lee
1
, J.W. Park
1
,
S.K. Ko
1
, S.W. Ko
1
, H.J. Choo
1
1
Kyung Hee University Hospital, Seoul, Republic of Korea;
2
Rosen
Hospital, Dongducheon, Republic of Korea
Background:
There is limited literature describing clinical
predictors for critically ill patients with cancer who present to
the emergency department (ED).
Purpose:
This study aimed to investigate the potential of SOFA
score as a predictor of death within 14 days in elderly patients with
advanced cancer admitted to the emergency department (ED).
Methods:
This was a prospective observational study of 124
consecutive elderly patients (≥65 years old) with advanced cancer
who presented to the ED. The outcome was defined as death within
14 days after admission.
Results:
The median survival time of the study subjects was 27.1
days (interquartile range, 9.1–77.2 days), and 35 patients (28.2%)
died within 14 days after admission. In univariate analysis, SOFA
score (≥4), previous chemotherapy, and altered mental status were
predictive of 14-day mortality. Of those variables, only SOFA score
was an independent predictor in multivariate analysis.
Conclusions:
The SOFA score may provide information on death
within 14 days after the ED visit in elderly patients with advanced
cancer. This score can help clinicians to predict 14-day mortality
and plan appropriate treatment for critically ill patients with cancer
who present to the ED.
P-178
Communication of a hospital DNACPR order in the discharge
summary in an acute London hospital
T. Cronin
1
, M. Pelly
2
, E. Baldwin
1
, Y. Khan
2
1
Chelsea and Westminster Hospital, London, United Kingdom;
2
Chelsea and Westminster Hospital, London
Background:
In 2012, the UK National Confidential Enquiry into
Patient Outcome and Death (NCEPOD) produced a report stating
‘there is a requirement for a robust system to ensure
. . .
effective
communication of DNACPR decisions between all healthcare
workers and organisations involved with the patient’. The report
also recommends CPR status should be recorded for all acute
admissions. Consequently, this indicates a considerable group of
patients who will be discharged with a hospital made DNACPR
order. Indeed, previous research, reporting on outcomes of patients
with DNACPR orders made in a UK hospital, found that 50%
went on to be discharged. In addition to this, there exists
significant regional variation in the validity of Hospital DNACPR
orders in the community. This further illustrates the need for
good communication of DNACPR orders in the hospital discharge
summary.
Methods:
Data were collected from discharged hospital inpatients
in three medical firms over a four month period.
Results:
Over the four month period 15% of patients discharged
with DNACPR order had this communicated in the discharge
summary.
Conclusion:
A low proportion of hospital DNACPR orders
are communicated to GPs. Recommendations to improve
communication includes having a section on whether a DNACPR
order was completed added to the discharge summary pro forma.
In addition, a clear pathway could be detailed on the DNACPR form
on how it should be communicated across different settings.
P-179
Effectiveness of the implementation of a protocol for palliative
sedation in hospitalized older patients
L. Garc´ıa Cabrera
1
, S. Fern ´andez-Villaseca
2
, J. Alb ´eniz-L ´opez
2
,
P. Fern ´andez-Montalb ´an
2
, L. Rexach-Cano
3
, A.J. Cruz-Jentoft
4
1
Hospital Ram´on y Cajal, Madrid, Spain;
2
H.U. Ram´on y Cajal, Madrid,
Spain;
3
Hospital Ramon Y Cajal, Madrid, Spain;
4
Hospital Universitario
Ram´on y Cajal, Madrid, Spain
Objective:
To determine the effectiveness of a protocol for palliative
sedation (PS) in older patients admitted for acute hospital care.
Methods:
Observational retrospective study. All patients older than
65 years who were sedated with palliative intent with midazolam
in two three-months periods – before and after the implementation