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Trail making test B in postoperative delirium: a replication study.

Marinus Fislage1,2, Insa Feinkohl3,4, Friedrich Borchers1

  • 1Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Berlin, Germany.

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Summary
This summary is machine-generated.

The Trail Making Test B (TMT-B) shows an association with postoperative delirium risk in older adults. However, TMT-B alone has low predictive power for clinical use.

Keywords:
Geriatric anaesthesiaOpen sciencePerioperative medicinePostoperative deliriumReplicationRisk predictionTrail making test

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Area of Science:

  • Geriatric Medicine
  • Neuropsychology
  • Surgical Outcomes

Background:

  • The Trail Making Test B (TMT-B) assesses cognitive flexibility and related domains.
  • Previous research on TMT-B and postoperative delirium risk is limited and inconsistent.
  • This study aimed to validate the association between preoperative TMT-B performance and postoperative delirium incidence.

Purpose of the Study:

  • To investigate the predictive value of the Trail Making Test B (TMT-B) for postoperative delirium in older surgical patients.
  • To confirm or refute previous findings on the association between TMT-B and delirium.
  • To assess the clinical utility of TMT-B as a standalone predictor of postoperative delirium.

Main Methods:

  • A binational, two-center, longitudinal observational cohort study included 841 older adults (≥65 years) undergoing major surgery without dementia.
  • Presurgical TMT-B scores were collected, and delirium was monitored twice daily using validated tools.
  • Logistic regression and ROC curve analysis were used to evaluate TMT-B's predictive performance, with sensitivity analyses for outliers and missing data.

Main Results:

  • 151 (18%) patients developed postoperative delirium.
  • TMT-B scores were significantly associated with delirium incidence (OR per 10-s increment 1.06; P=0.001).
  • The area under the ROC curve was 0.60 (P<0.001), indicating low predictive performance. Impaired or missing TMT-B data also predicted delirium (OR 2.74).

Conclusions:

  • The Trail Making Test B (TMT-B) is statistically associated with postoperative delirium.
  • However, TMT-B demonstrates low predictive performance as a standalone test.
  • TMT-B is not currently suitable for predicting delirium in clinical practice.