Background. Features that may allow early identification of patients at risk of prolonged delirium, and therefore of poorer outcomes, are not well understood. The aim of this study was to determine if preoperative delirium risk factors and delirium symptoms (at onset and clinical symptomatology during the course of delirium) are associated with delirium duration. Methods. This study was conducted in prospectively identified cases of incident delirium. We compared patients experiencing delirium of short duration (1 or 2 days) with patients who had more prolonged delirium (≥3 days) with regard to DRS-R-98 (Delirium Rating Scale Revised-98) symptoms on the first delirious day. Delirium symptom profile was evaluated daily during the delirium course. Results. In a homogenous population of 51 elderly hip-surgery patients, we found that the severity of individual delirium symptoms on the first day of delirium was not associated with duration of delirium. Preexisting cognitive decline was associated with prolonged delirium. Longitudinal analysis using the generalised estimating equations method (GEE) identified that more severe impairment of long-term memory across the whole delirium episode was associated with longer duration of delirium. Conclusion. Preexisting cognitive decline rather than severity of individual delirium symptoms at onset is strongly associated with delirium duration. 1. Introduction Postoperative delirium is a common complication in elderly hip-fracture patients, that is associated with high mortality, cognitive deterioration, and a high rate of subsequent institutionalization [1–3]. Delirium follows a variable course, ranging from a brief transient state to more persistent illness that can evolve into long-term cognitive impairment [4, 5]. Factors that may allow earlier identification of patients who are at risk of more prolonged delirium are not well understood [6, 7]. Although studies over the past decade have improved our understanding of the phenomenology of delirium, little is known about the association between specific delirium symptoms and duration of delirium [8]. Few studies have examined delirium symptoms as a risk factor for an extended duration of the delirious episode. Previous studies have used the Delirium Rating Scale (DRS) [9] to measure the severity of delirium symptoms [10, 11]. Rudberg et al. (1997) found that patients experiencing delirium of a single day’s duration did not differ from more persistent (multiple days) cases with regard to individual DRS item scores on the first day of delirium [10]. Conversely, Wada
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