Delirium prevention and treatment in the emergency department (ED): a systematic review protocol

Abstract

IntroductionDelirium is a dangerous syndrome of acute brain dysfunction that is common in the emergency department (ED), especially among the geriatric population. Most systematic reviews of interventions for delirium prevention and treatment have focused on inpatient settings. Best practices of effective delirium care in ED settings have not been established. The primary objective of this study is to identify pharmacologic and non-pharmacologic interventions as applied by physicians, nursing staff, pharmacists and other ED personnel to prevent incident delirium and to shorten the severity and duration of prevalent delirium in a geriatric population within the ED.Methods and analysisSearches using subject headings and keywords will be conducted from database inception through June 2020 in MEDLINE, EMBASE, Web of Science, PsychINFO, CINAHL, ProQuest Dissertations and Theses Global and Cochrane CENTRAL as well as grey literature. Database searches will not be limited by date or language. Two reviewers will identify studies describing any interventions for delirium prevention and/or treatment in the ED. Disagreements will be settled by a third reviewer. Pooled data analysis will be performed where possible using Review Manager. Risk ratios and weighted difference of means will be used for incidence of delirium and other binary outcomes related to delirium, delirium severity or duration of symptoms, along with 95% CIs. Heterogeneity will be measured by calculating I2, and a forest plot will be created. If significant heterogeneity is identified, metaregression is planned using OpenMeta to identify possible sources of heterogeneity.Ethics and disseminationThis is a systematic review of previously conducted research; accordingly, it does not constitute human subjects research needing ethics review. This review will be prepared as a manuscript and submitted for publication to a peer-reviewed journal, and the results will be presented at conferences.PROSPERO trial registration numberCRD42020169654.

Managing delirium in acute inpatient units: A cross‐sectional study of nursing teams' knowledge and perceived limitations

“…This could be due to the inherent characteristics of that department (work overload and high caseload), as well as the fact that it has the least experienced staff. Comparison with other studies was not possible due to the paucity of research on delirium in emergency departments (Dahlstrom et al, 2020).…”

Can we improve delirium prevention and treatment in the emergency department? A systematic review

“…The study follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) 23 . The study protocol was registered to PROSPERO (CRD42020169654) 21 …”

“…Since 2012, four Cochrane reviews summarized pharmacologic and nonpharmacologic delirium interventions in both the hospital setting and long‐term care 14,17,19,20 . The generalizability of pharmacological and nonpharmacological interventions to the ED setting may be limited due to resource constraints and heterogeneous patient populations 21 …”

“…14,17,19,20 The generalizability of pharmacological and nonpharmacological interventions to the ED setting may be limited due to resource constraints and heterogeneous patient populations. 21 To date, no systematic review has been published assessing delirium prevention or intervention programs targeted at older adults in the ED.…”

Balancing vision with pragmatism: The geriatric emergency department guidelines‐realistic expectations from emergency medicine and geriatric medicine

“…Developing key outcome measures for effective and sustainable delirium quality improvement will require local physicians and nurse champions to ensure all staff are educated and aligned with similar goals along with institutional support for ongoing efforts 22 . Perhaps the highest priority challenge for delirium experts is to evaluate and publish effective delirium intervention strategies since current evidence is completely lacking for ED‐based delirium prevention or treatment 23,24 …”