Epidemiology of delirium in hospitalized patients in Latin America: A systematic review

Abstract

BackgroundAccurate epidemiological data are essential for the planning of policies aimed at the identification, prevention, and management of delirium. The reported occurrence of delirium in hospitalized patients varies widely among studies, ranging between 5% to more than 80% in the international literature. The exact occurrence in Latin America is not well described.ObjectiveThe aim of this study is to conduct a systematic analysis of the published data on the epidemiology of delirium in hospitalized patients in Latin America.MethodsWe conducted a systematic review following PRISMA guidelines. Both MEDLINE and LILACS databases were searched for original research articles reporting the occurrence of delirium among adult hospitalized patients in Latin American countries. Studies including pediatric populations were excluded from this analysis. Two authors independently applied eligibility criteria, assessed quality, and extracted data. The corresponding authors of the original articles were contacted to obtain relevant information about the study when this was not present in the published manuscripts.ResultsSeven hundred and eighteen original articles were identified. After screening titles and abstracts, 149 studies were included in the final analysis. The occurrence of delirium varied depending on the clinical scenario: (1) in the general medico‐surgical wards, it ranged from 2.1% to 60.4%, (2) in the Intensive Care Units (ICUs), from 9.6% to 94.8%, (3) in the post‐operatory population, from 5.45% and 52.3%, and (4) it was found to be between 10.7% and 62% in the emergency department setting. The most used delirium assessment tools were the “Confusion Assessment Method” (CAM; in the general population), and the “Confusion Assessment Method for the ICU” (CAM‐ICU). Fourteen out of 149 studies were conducted in clinical settings who actively implemented some form of non‐pharmacological delirium prevention bundles, most of them as part of ICU sedation‐analgesia protocols.ConclusionDelirium occurs frequently in hospitalized patients in Latin America throughout a variety of clinical scenarios, including ICU, general wards, post‐operatory populations, and among the emergency department setting. The CAM and the CAM‐ICU are the most used delirium assessment tools. Bundles of non‐pharmacological interventions to prevent delirium are not universally implemented.

Spanish Translation and Cultural Adaptation of the Intensive Care Unit Delirium Playbook

“…Although a Spanish-language version of the CAM-ICU was developed and validated in 2010, delirium screening in primarily Spanish-speaking ICUs is poor, with one study in Spain reporting only 21% of 166 ICUs performing standard-of-care screening for delirium ( 14 , 17 ). In addition, despite the CAM-ICU being the most commonly used delirium assessment tool in Latin America, a survey of 854 ICU providers from 12 Latin American countries revealed that only 19% of them regularly use the CAM-ICU, potentially leading to missed delirium ( 18 , 19 ). Moreover, in English-speaking countries, ICU providers report discomfort with performing delirium assessments in adults with low English proficiency, with 56% of providers in one study reporting lack of confidence in evaluating their patients with low English proficiency for delirium ( 20 ).…”

Beyond confusion: Embedding psychiatry in delirium research and clinical practice

“…Incidence and prevalence of delirium are matters of great uncertainty, and this is even less clear for hospitals outside Europe and the United States. In a systematic review, Bravo et al 4 conclude that delirium prevalence in Latin American hospitals is similar to what is internationally reported; however, very few hospitals had implemented intervention packages, highlighting opportunities for improvement. Delirium is common in early as well as later life, but research on its occurrence is limited.…”

Non-pharmacological interventions for delirium in the pediatric population: a systematic review with narrative synthesis

“…The epidemiology of delirium in hospitalized patients varies across clinical scenarios, with common occurrences in medical-surgical wards, intensive care units (ICUs), postoperative populations, and emergency departments. The prevalence ranges from 2.1 to 94.8% in adults [ 5 ]. Delirium also occurs in hospitalized children in diverse settings, with pediatric delirium estimated to occur in 34% of critical care admissions [ 6 ], and emergence delirium in over 40% of patients in postoperative surgery care [ 7 ].…”