Delirium in hospitalized patients: implications of current evidence on clinical practice and future avenues for research--a systematic evidence review.
BACKGROUND
Despite the significant burden of delirium among hospitalized adults, critical appraisal of systematic data on delirium diagnosis, pathophysiology, treatment, prevention, and outcomes is lacking.


OBJECTIVE
To provide evidence-based recommendations for delirium care to practitioners, and identify gaps in delirium research.


METHODS
Medline, PubMed, the Cochrane Library, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) information systems from January 1966 to April 2011.


METHODS
All published systematic evidence reviews (SERs) on delirium were evaluated.


METHODS
Three reviewers independently extracted the data regarding delirium risk factors, diagnosis, prevention, treatment, and outcomes, and critically appraised each SER as good, fair, or poor using the United States Preventive Services Task Force criteria.


RESULTS
Twenty-two SERs graded as good or fair provided the data. Age, cognitive impairment, depression, anticholinergic drugs, and lorazepam use were associated with an increased risk for developing delirium. The Confusion Assessment Method (CAM) is reliable for delirium diagnosis outside of the intensive care unit. Multicomponent nonpharmacological interventions are effective in reducing delirium incidence in elderly medical patients. Low-dose haloperidol has similar efficacy as atypical antipsychotics for treating delirium. Delirium is associated with poor outcomes independent of age, severity of illness, or dementia.


CONCLUSIONS
Delirium is an acute, preventable medical condition with short- and long-term negative effects on a patient's cognitive and functional states.
Indiana University School of Medicine, Indianapolis, IN, USA. bakhan@iupui.edu
Babar A
BA
Khan
Mohammed
M
Zawahiri
Noll L
NL
Campbell
George C
GC
Fox
Eric J
EJ
Weinstein
Arif
A
Nazir
Mark O
MO
Farber
John D
JD
Buckley
Alasdair
A
Maclullich
Malaz A
MA
Boustani
D014150:Antipsychotic Agents / Q000627:therapeutic use; D003693:Delirium / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D019317:Evidence-Based Medicine; D006801:Humans; D007297:Inpatients; D012307:Risk Factors; D013577:Syndrome; D016896:Treatment Outcome
D014150:Antipsychotic Agents