World Journal of Surgery

, Volume 42, Issue 5, pp 1340–1345 | Cite as

Clock-Drawing Test as a Bedside Assessment of Post-operative Delirium Risk in Elderly Patients with Accidental Hip Fracture

  • Claudia C. Vasilian
  • Simona C. Tamasan
  • Diana Lungeanu
  • Dan V. Poenaru
Original Scientific Report



Currently applied cognitive tests for assessing the risk of post-operative delirium require time and specialised medical staff, in addition to the patients’ mental strain. We investigated the four-point scoring Clock-Drawing Test (CDT-4) as a preoperative independent predictor for post-operative delirium.


A total of 100 consecutive patients aged over 65 years admitted for accidental hip fracture were assessed for delirium using the Confusion Assessment Method Scale. The cognitive function was rated with mini–mental state examination, Montreal Cognitive Assessment Scale (MoCA), and CDT-4. Descriptive statistics were performed, and a logistic regression model for post-operative delirium was applied.


Out of the 100 enrolled patients 98 underwent hip repair surgery and 65 (66%) had post-operative delirium, with 24 (42%) incident cases. The median (IQR) ages were 78 (72–83) and 84 (80–87) years for the non-delirium and post-operative delirium groups, respectively. The logistic regression concluded with age and CDT-4 as independent preoperative predictors, while controlling for gender, pre-surgery delirium, MoCA visual, and MoCA attention: OR 1.32 [95% CI (1.099–1.585); p = 0.003] for age; OR 0.153 [95% CI (0.033–0.719); p = 0.017] for CDT-4.


Employing CDT-4 as a bedside assessment of delirium risk may help to preoperatively stratify and prioritise the patients for preventive perioperative care in a timely manner.



The first author’s doctoral research was funded by the Ph.D. Grant Number I-C3-GD-2014.

Compliance with ethical standards

Conflict of interest

None declared.


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Claudia C. Vasilian
    • 1
    • 2
  • Simona C. Tamasan
    • 2
  • Diana Lungeanu
    • 3
  • Dan V. Poenaru
    • 2
    • 4
  1. 1.“Victor Babes” University of Medicine and PharmacyTimisoaraRomania
  2. 2.“Pius Branzeu” Emergency County HospitalTimisoaraRomania
  3. 3.Department of Functional Sciences, Centre for Modelling Biological Systems and Data Analysis“Victor Babes” University of Medicine and PharmacyTimisoaraRomania
  4. 4.Department of Orthopaedics and Traumatology“Victor Babes” University of Medicine and PharmacyTimisoaraRomania

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