Are patients with fractured hips giving valid consent for surgery?

Abstract

Introduction: Proximal femoral fractures (intracapsular and extracapsular) most commonly occur in the elderly due to falls, with a higher incidence in women. With the UK population ageing, the incidence of fracture neck of femurs (NOF) has been steadily increasing. In 2007 there were 70,000 NOF fractures treated in the NHS. This number is expected to rise to 91,500 per annum by 2015. The aim of this observational prospective study was to see whether consent comprehension was related to AMTS in an elderly patient with a proximal femoral fracture. Materials and methods: Sixty four patients with hip fractures were included in this study. The patient was consented and an abbreviated mental test score (AMTS) was recorded on admission. Preoperative comprehension was judged using a questionnaire. Univariable linear regression analysis was performed. Results: A significant correlation between the AMTS and consent comprehension scores was found r² = 0.680 (p<0.0001). Conclusion: We showed a strong correlation between the AMTS and consent comprehension in this patient group. We concluded that due to variation in comprehension scores for a defined AMTS, we could not state above what AMTS a patient can be deemed to have significant comprehension of their consent. Consent training should me mandatory for surgical doctors and that it should not be a one off event, but instead a continuum of events.