A critical appraisal and recommendation synthesis of delirium clinical practice guidelines relevant to the care of older adults in the emergency department: An umbrella review DOI Creative Commons
Sarah Filiatreault, Jeremy Grimshaw, Sara A. Kreindler

et al.

Journal of Evaluation in Clinical Practice, Journal Year: 2023, Volume and Issue: 29(6), P. 1039 - 1053

Published: June 14, 2023

Abstract Rationale Older adults are at high risk of developing delirium in the emergency department (ED); however, it is often missed or undertreated. Improving ED care challenging part due to a lack standards guide best practice. Clinical practice guidelines (CPGs) translate evidence into recommendations improve Aim To critically appraise and synthesize CPG for relevant older patients. Methods We conducted an umbrella review retrieve CPGs. Quality CPGs their were appraised using Appraisal Guidelines, Research, Evaluation (AGREE)‐II; Guidelines Research Evaluation—Recommendations Excellence (AGREE‐REX) instruments. A threshold 70% greater AGREE‐II Rigour Development domain was used define high‐quality Delirium from meeting this included synthesis narrative analysis. Results scores ranged 37% 83%, with 5 10 predefined threshold. AGREE‐REX overall calculated 44% 80%. Recommendations grouped screening, diagnosis, reduction, management. Although none ED‐specific, many incorporated setting. There agreement that screening nonmodifiable factors important high‐risk populations, those should be screened delirium. The ‘4A's Test’ recommended tool use specifically. Multicomponent strategies its management if occurs. only area disagreement short‐term antipsychotic medication urgent situations. Conclusion This first known including critical appraisal recommendations. Researchers policymakers can inform future improvement efforts research ED. Registration study has been registered Open Science Framework registries: https://doi.org/10.17605/OSF.IO/TG7S6OSF.IO/TG7S6 .

Language: Английский

Delirium Prevention and Management in Older Adults in the Emergency Department DOI
Rachel M. Skains, Sangil Lee, Jin H. Han

et al.

Emergency Medicine Clinics of North America, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

Citations

0
Boarding in the Emergency Department DOI
Joshua W. Joseph,

Allan D. Rosen,

Maura Kennedy

et al.

Emergency Medicine Clinics of North America, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

Citations

0
People living with dementia deserve the best care possible in the emergency department DOI Creative Commons
Celeste Fung, Debra Eagles, Hans Rosenberg

et al.

Canadian Journal of Emergency Medicine, Journal Year: 2025, Volume and Issue: unknown

Published: March 3, 2025

Language: Английский

Citations

0
Impact of Implantable Hearing Devices on Delirium Risk in Patients with Hearing Loss: A National Database Study DOI

Bryce Hambach,

Jena Patel, Kathryn L. Nunes

et al.

Otology & Neurotology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 24, 2025

Objective Exploring whether the utilization of implantable hearing rehabilitation devices is associated with a reduced likelihood developing delirium in patients loss. Study Design A retrospective cohort database study propensity score matching (PSM) utilizing TriNetX clinical database. Setting The US Collaborative Network within (100 million people). Patients over 55 years old were selected based on three categories: non–hearing loss control (ICD-10: H90–91), (HL without device), and an device Z96.21, Z96.29, 09HD, 09HE; CPT: 69714, 69930). prior dementia or memory diagnosis excluded (F01–03, 27–29). Interventions Observational. Main Outcome Measures Odds ratios 95% confidence intervals for code (F0.5). Results (n = 36.5 million) was 1:1 PSM age sex HL 1.77 which 0.28% developed compared to 0.74% (OR 2.66, CI 2.58–2.75). When looking at same between cohorts 20,847), 0.81% 0.45% 1.79, 1.39–2.31). Further analysis accounting 16 covariates showed that 1.64, 1.27–2.13). Conclusions present shows more likely develop than those normal hearing. Importantly, significantly less device. Our research highlights importance treating prevent delirium. Level Evidence: III.

Language: Английский

Citations

0
Neuron-specific enolase and Tau protein as biomarkers for sepsis-associated delirium: a cross-sectional pilot study DOI Creative Commons
Agnes Araújo Sardinha Pinto, Maira Mello de Carvalho, J Santos

et al.

Einstein (São Paulo), Journal Year: 2025, Volume and Issue: 23

Published: Jan. 1, 2025

In this study, Pinto et al. identified significantly higher levels of neuron-specific enolase and Tau protein in older patients with sepsis-associated delirium the emergency department, suggesting potential these biomarkers as diagnostic tools population. Sepsis-associated is a common cerebral manifestation sepsis, potentially caused by combination neuroinflammation other neurophysiological disorders. This study investigated expression delirium. While are known to be associated brain injury, their not well understood. cross-sectional pilot evaluated plasma sepsis explore for identifying admitted department. A total 25 were analyzed, 56% whom had sepsis. Patients exhibited (2.7ng/mL [95%CI= 2.2-3.2] versus 1.3 ng/mL 0.8-2.5], p<0.003) (96.1pg/mL 77.0-111.3] 43.0pg/mL 31.2-84.5], compared without Neuron-specific thresholds >2.08ng/mL >59.27pg/mL, respectively, demonstrated 90% specificity patients. than those without, underscoring ability identify infectious etiology departments. Clinical Trials #RBR-233bct. ■ Biomarkers such proteins, Diagnosing can challenging. Early identification key managing sepsisassociated

Language: Английский

Citations

0
Alterations in the gut microbiome and metabolome in elderly patients with postoperative delirium: A prospective nested case-control study DOI Creative Commons

Jiang Huo,

Shuping Han, Xinyu Hao

et al.

Journal of Clinical Anesthesia, Journal Year: 2025, Volume and Issue: 103, P. 111833 - 111833

Published: April 1, 2025

To elucidate the role of gut microbiota and their metabolites, including short-chain fatty acids (SCFAs) targeted metabolomics, in development postoperative delirium (POD) elderly patients. Prospective nested case-control study. A Chinese tertiary hospital. Elderly patients underwent elective orthopedic surgery. Participants were assessed for POD using 3-min Diagnostic Confusion Assessment Method (3D-CAM). Biological samples, feces plasma, collected. 1:1 propensity score matching (PSM) was conducted to match cases with non-POD cases. 16S ribosomal RNA (rRNA) sequencing metabolomics analyses performed on matched case series. Predictive models developed logistic regression analysis, incorporating bacterial genera metabolites that exhibited significant differences between two groups as predictors. Among 234 who followed up, 41 diagnosed POD. total 39 both control PSM. No found α-diversity β-diversity preoperative groups. However, specific genera, Romboutsia, Bacteroides faecalis, Blautia mucilaginosa, Eggerthella lenta, differences. The risk associated higher plasma levels propionic acid, histidine, aspartate, ornithine. Logistic receiver operating characteristic curve revealed indicators derived from could predict POD, an area under 0.8413 (95 % confidence interval (CI): 0.7393-0.9434). This study identified four increased patients, suggesting potential metabolite profiles biomarkers improving prediction guiding interventions.

Language: Английский

Citations

0
Altered Tryptophan-Kynurenine Pathway in Delirium: A Review of the Current Literature DOI Open Access
Hui Phing Ang, Suzana Makpol, Muhammad Luqman Nasaruddin

et al.

International Journal of Molecular Sciences, Journal Year: 2023, Volume and Issue: 24(6), P. 5580 - 5580

Published: March 15, 2023

Delirium, a common form of acute brain dysfunction, is associated with increased morbidity and mortality, especially in older patients. The underlying pathophysiology delirium not clearly understood, but systemic inflammation known to drive cases illnesses, such as sepsis, trauma, surgery. Based on psychomotor presentations, has three main subtypes, hypoactive, hyperactive, mixed subtype. There are similarities the initial presentation depression dementia, hypoactive Hence, patients frequently misdiagnosed. altered kynurenine pathway (KP) promising molecular implicated pathogenesis delirium. KP highly regulated immune system influences neurological functions. activation indoleamine 2,3-dioxygenase, specific neuroactive metabolites, quinolinic acid kynurenic acid, could play role event Here, we collectively describe roles speculate its relevance

Language: Английский

Citations

9
Developing a set of emergency department performance measures to evaluate delirium care quality for older adults: a modified e-Delphi study DOI Creative Commons
Sarah Filiatreault, Sara A. Kreindler, Jeremy Grimshaw

et al.

BMC Emergency Medicine, Journal Year: 2024, Volume and Issue: 24(1)

Published: Feb. 15, 2024

Abstract Background Older adults are at high risk of developing delirium in the emergency department (ED); however, it is under-recognized routine clinical care. Lack detection and treatment associated with poor outcomes, such as mortality. Performance measures (PMs) needed to identify variations quality care help guide improvement strategies. The purpose this study gain consensus on a set statements PMs that can be used evaluate for older ED patients. Methods A 3-round modified e-Delphi was conducted experts. In each round, participants rated according concepts importance actionability, then their concept necessity (1–9 Likert scales), ability comment each. Consensus stability were evaluated using priori criteria descriptive statistics. Qualitative data examined themes within across PMs, which went through participant validation exercise final round. Results Twenty-two experts participated, 95.5% from west or central Canada. From 10 24 achieved six 22 PMs. supported justification including three one PM slightly below criteria. Three overarching emerged qualitative related statement actionability. Nine statements, nine structure 14 process included set, addressing four areas care: screening, diagnosis, reduction management. Conclusion provide important, actionable, necessary diverse group To our knowledge, first known develop de novo guideline-based receive setting.

Language: Английский

Citations

3
Delirium detection in the emergency department: A diagnostic accuracy meta‐analysis of history, physical examination, laboratory tests, and screening instruments DOI
Christopher R. Carpenter, Sangil Lee,

Maura Kennedy

et al.

Academic Emergency Medicine, Journal Year: 2024, Volume and Issue: 31(10), P. 1014 - 1036

Published: May 16, 2024

Abstract Introduction Geriatric emergency department (ED) guidelines emphasize timely identification of delirium. This article updates previous diagnostic accuracy systematic reviews history, physical examination, laboratory testing, and ED screening instruments for the diagnosis delirium as well test–treatment thresholds screening. Methods We conducted a review to quantify approaches identify Studies were included if they described adults aged 60 or older evaluated in setting with an index test compared acceptable criterion standard Data extracted studies reviewed risk bias. When appropriate, we meta‐analysis estimated thresholds. Results Full‐text was performed on 55 27 current analysis. No identified exploring findings history While two reported clinicians accurately rule delirium, clinician gestalt is inadequate out report three that quantified 4 A's Test (4AT) (pooled positive likelihood ratio [LR+] 7.5, 95% confidence interval [CI] 2.7–20.7) negative [LR−] 0.18, CI 0.09–0.34) also Abbreviated Mental Test‐4 (AMT‐4) found pooled LR+ (4.3, 2.4–7.8) lower than observed 4AT, but LR− (0.22, 0.05–1) similar. Based one study Confusion Assessment Method Intensive Care Unit (CAM‐ICU) superior instrument The calculated threshold 2% treatment 11%. Conclusions quantitative examination virtually unexplored. 4AT has largest quantity ED‐based research. Other may more If goal then CAM‐ICU brief CAM modified are instruments, although these tools based single‐center studies. To Delirium Triage Screen study.

Language: Английский

Citations

3
Risk factors and risk stratification approaches for delirium screening: A Geriatric Emergency Department Guidelines 2.0 systematic review DOI
Justine Seidenfeld, Sangil Lee,

Luna Ragsdale

et al.

Academic Emergency Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: June 7, 2024

Abstract Objective As part of the Geriatric Emergency Department (ED) Guidelines 2.0 project, we conducted a systematic review to find risk factors or stratification approaches that can be used identify subsets older adults who may benefit from targeted ED delirium screening. Methods An electronic search strategy was developed with medical librarian, in April 2021 and November 2022. Full‐text studies patients ≥65 years assessed for prevalent were included. Risk bias using McMaster University Clarity Group tool. Outcomes measures pertained method used. Due heterogeneity patient populations, methods, outcomes, meta‐analysis not conducted. Results Our yielded 1878 unique citations, which 13 Six novel score without evaluation specific factors, six evaluated only, one study an existing nondelirium association delirium. The most common factor history dementia, odds ratios ranging 3.3 (95% confidence interval [CI] 1.2–8.9) 18.33 CI 8.08–43.64). Other consistently associated increased included age, use certain medications (such as antipsychotics, antidepressants, opioids, among others), functional impairments. Of scores, reported area under curve ranged 0.77 0.90. Only two potential impact tool on screening burden. Conclusions There is significant heterogeneity, but results suggest such age over 75, impairments should are at highest No implementation patient‐oriented outcomes.

Language: Английский

Citations

3