References: Multicomponent Assessment, Treatment, And Prevention Of Delirium In Hospitalized Patients

<< Multicomponent Assessment, Treatment, And Prevention Of Delirium In Hospitalized Patients


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

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  24. Greer N, Rossom R, Anderson P, et al. Delirium: screening, prevention, and diagnosis - a systematic review of the evidence. Evidence-based Synthesis Program (ESP) Center, Minneapolis VA Medical Center. Department of Veterans Affairs (US):Washington (DC);2011. (Government report)
  25. Young J, Murthy L, Westby M, et al. Diagnosis, prevention, and management of delirium: summary of NICE guidance. BMJ. 2010;341:c3704. (Clinical guideline)
  26. Inouye SK, Foreman MD, Mion LC, et al. Nurses’ recognition of delirium and its symptoms: comparison of nurse and researcher ratings. Arch Intern Med. 2001;161(20):2467-2473. (Prospective; 797 patients)
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  30. Marcantonio ER, Ngo LH, O’Connor M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161(8):554-561. (Prospective; 201 patients)
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  34. Naughton BJ, Moran M, Ghaly Y, et al. Computed tomography scanning and delirium in elder patients. Acad Emerg Med. 1997;4(12):1107-1110. (Prospective observation study; 560 patients)
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  36. Theisen-Toupal J, Breu AC, Mattison ML, et al. Diagnostic yield of head computed tomography for the hospitalized medical patient with delirium. J Hosp Med. 2014;9(8):497-501. (Retrospective study; 398 patients)
  37. Metersky ML, Williams A, Rafanan AL. Retrospective analysis: are fever and altered mental status indications for lumbar puncture in a hospitalized patient who has not undergone neurosurgery? Clin Infect Dis. 1997;25(2):285-288. (Retrospective; 232 patients)
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  39. Siddiqi N, Stockdale R, Britton AM, et al. Interventions for preventing delirium in hospitalised patients. Cochrane Database Syst Rev. 2007(2):CD005563. (Systematic review)
  40. Sheth RD, Drazkowski JF, Sirven JI, et al. Protracted ictal confusion in elderly patients. Arch Neurol. 2006;63(4):529-532. (Case series; 22 patients) 
  41. Inouye SK, Bogardus ST Jr, Charpentier PA, et al. A Multi­component intervention to prevent delirium in hospitalized older patients. N Engl J Med. 1999.340:669-676. (Prospective trial; 852 patients)
  42. Siddiqi N, Stockdale R, Britton AM, et al. Interventions for preventing delirium in hospitalised patients. Cochrane Database Syst Rev. 2007(2):CD005563. (Systematic review)
  43. Mudge AM, Maussen C, Duncan J, et al. Improving quality of delirium care in a general medical service with established interdisciplinary care: a controlled trial. Intern Med J. 2013;43(3):270-277. (Prospective randomized controlled trial; 206 patients)
  44. Finotto S, Artioli G, Davoli L, et al. Nursing interventions for the prevention of the delirium in intensive care unit (ICU): a randomized study. Prof Inferm. 2006;59(4):228-232. (Prospective randomized controlled trial; 48 patients)
  45. Holt R, Young J, Heseltine D. Effectiveness of a multi-component intervention to reduce delirium incidence in elderly care wards. Age Ageing. 2013;42(6):721-727. (Prospective nonrandomized controlled trial; 436 patients) 
  46. Martinez F, Tobar C, Hill N. Preventing delirium: should non-pharmacological, multicomponent interventions be used? A systematic review and meta-analysis of the literature. Age Ageing. 2015;44(2):196-204. (Systematic review and meta-analysis) 
  47. Marcantonio ER, Flacker JM, Wright RJ, et al. Reducing delirium after hip fracture: a randomized trial. J Am Geriatr Soc. 2001;49(5):516-522. (Prospective randomized controlled trial; 126 patients)
  48. Martinez FT, Tobar C, Beddings CI, et al. Preventing delirium in an acute hospital using a non-pharmacological intervention. Age Ageing. 2012;41(5):629-634. (Prospective randomized controlled trial; 287 patients) 
  49. Vidan MT, Sanchez E, Alonso M, et al. An intervention integrated into daily clinical practice reduces the incidence of delirium during hospitalization in elderly patients. J Am Geriatr Soc. 2009;57(11):2029-2036. (Prospective nonrandomized controlled trial; 542 patients)
  50. The American Geriatrics Society Expert Panel On Postoperative Delirium In Older Adults. postoperative delirium in older adults: best practice statement from the American Geriatrics Society. J Am Coll Surg. 2014. (Clinical guideline) 
  51. Robinson S, Vollmer C. Undermedication for pain and precipitation of delirium. Medsurg Nurs. 2010;19(2):79-83; quiz 84. (Retrospective case-control; 86 patients)
  52. Morrison RS, Magaziner J, Gilbert M, et al. Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci. 2003;58(1):76-81. (Prospective cohort; 541 patients) 
  53. Lynch EP, Lazor MA, Gellis JE, et al. The impact of postoperative pain on the development of postoperative delirium. Anesth Analg. 1998;86(4):781-785. (Prospective observational) 
  54. Vaurio LE, Sands LP, Wang Y, et al. Postoperative delirium: the importance of pain and pain management. Anesth Analg. 2006;102(4):1267-1273. (Prospective observational; 333 patients)
  55. Krenk L, Rasmussen LS, Hansen TB, et al. Delirium after fast-track hip and knee arthroplasty. Br J Anaesth.  2012;108(4):607-611. (Prospective observation; 225 patients)
  56. Leung JM, Sands LP, Rico M, et al. Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients.Neurology. 2006;67(7):1251-1253. (Prospective randomized controlled trial; 21 patients)
  57.  ong HK, Sands LP, Leung JM. The role of postoperative analgesia in delirium and cognitive decline in elderly patients: a systematic review. Anesth Analg. 2006;102(4):1255-1266. (Systematic review)
  58. Marcantonio ER, Juarez G, Goldman L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA. 1994;272(19):1518-1522. (Nested case-control study; 245 patients)
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  62. Larsen KA, Kelly SE, Stern TA, et al. Administration of olanzapine to prevent postoperative delirium in elderly joint-replacement patients: a randomized, controlled trial. Psychosomatics. 2010;51(5):409-418. (Prospective randomized controlled trial; 495 patients)
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  66. Page VJ, Ely EW, Gates S, et al. Effect of intravenous haloperidol on the duration of delirium and coma in critically ill patients (Hope-ICU): a randomised, double-blind, placebo-controlled trial. Lancet Respir Med. 2013;1(7):515-523. (Prospective randomized controlled trial; 141 patients)
  67. Vochteloo AJ, Moerman S, van der Burg BL, et al. Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium. BMC Geriatr. 2011;11:39. (Prospective cohort; 445 patients)
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  70. Lonergan E, Britton AM, Luxenberg J, et al. Antipsychotics for delirium. Cochrane Database Syst Rev. 2007(2):CD005594. (Systematic review)
  71. Han CS, Kim YK. A double-blind trial of risperidone and haloperidol for the treatment of delirium. Psychosomatics. 2004;45(4):297-301. (Prospective randomized controlled study; 28 patients)
  72. Ballard C, Hanney ML, Theodoulou M, et al. The Dementia Antipsychotic Withdrawal Trial (DART-AD): long-term follow-up of a randomised placebo-controlled trial. Lancet Neurol. 2009;8(2):151-157. (Prospective randomized controlled trial; 165 patients)
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  77. Bradley EH, Webster TR, Baker D, et al. After adoption: sustaining the innovation. A case study of disseminating the hospital elder life program. J Am Geriatr Soc. 2005;53(9):1455- 1461. (Longitudinal qualitative study)
  78. Fick DM, Steis MR, Waller JL, et al. Delirium superimposed on dementia is associated with prolonged length of stay and poor outcomes in hospitalized older adults. J Hosp Med. 2013;8(9):500-505. (Prospective cohort; 139 patients)
  79. Francis J, Kapoor WN. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc. 1992;40(6):601-606. (Descriptive cohort; 223 patients)
  80.  Kiely DK, Marcantonio ER, Inouye SK, et al. Persistent delirium predicts greater mortality. J Am Geriatr Soc. 2009;57(1):55- 61. (Observational cohort; 412 patients)
  81. McCusker J, Cole MG, Dendukuri N, et al. Does delirium increase hospital stay? J Am Geriatr Soc. 2003;51(11):1539-1546. (Prospective cohort study; 359 patients)
  82. Overshott R, Karim S, Burns A. Cholinesterase inhibitors for delirium. Cochrane Database Syst Rev. 2008(1):CD005317. (Systematic review)
  83. Marcantonio ER, Palihnich K, Appleton P, et al. Pilot randomized trial of donepezil hydrochloride for delirium after hip fracture. J Am Geriatr Soc. 2011;59 Suppl 2:S282-288. (Prospective randomized controlled trial; 16 patients)
  84. Cole MG, Ciampi A, Belzile E, et al. Persistent delirium in older hospital patients: a systematic review of frequency and prognosis. Age Ageing. 2009;38(1):19-26. (Systematic review) 
  85. Leslie DL, Marcantonio ER, Zhang Y, et al. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27-32. (Retrospective cost analysis; 841 patients)
  86. Leslie DL, Inouye SK. The importance of delirium: economic and societal costs. J Am Geriatr Soc. 2011;59 Suppl 2:S241-243. (Review)
  87. Rizzo JA, Bogardus ST, Jr., Leo-Summers L, et al. Multicomponent targeted intervention to prevent delirium in hospitalized older patients: what is the economic value? Med Care. 2001;39(7):740-752. (Retrospective cost analysis; 852 patients)
  88.  Zaubler TS, Murphy K, Rizzuto L, et al. Quality improvement and cost savings with multicomponent delirium interventions: replication of the Hospital Elder Life Program in a community hospital. Psychosomatics. 2013;54(3):219-226. (Prospective observational study; 595 patients)
  89. Strijbos MJ, Steunenberg B, van der Mast RC, et al. Design and methods of the Hospital Elder Life Program (HELP), a multicomponent targeted intervention to prevent delirium in hospitalized older patients: efficacy and cost-effectiveness in Dutch health care. BMC Geriatr. 2013;13:78. (Description of stepped-wedge-design study)  
Publication Information

Frank Merritt, MD; Ethan Cumbler, MD, FACP, FHM

Publication Date

March 1, 2015

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