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Emergency medicine
Protocol
Delirium prevention and treatment in the emergency department (ED): a systematic review protocol
  1. Elijah Blue Dahlstrom1,
  2. Jin Ho Han2,
  3. Heather Healy3,
  4. Maura Kennedy4,
  5. Glenn Arendts5,
  6. Jacques Lee6,
  7. Chris Carpenter7,
  8. Sangil Lee8
  1. 1Department of Emergency Medicine, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
  2. 2Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA
  3. 3University of Iowa Libraries, University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
  4. 4Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5The University of Western Australia, Perth, Western Australia, Australia
  6. 6University of Toronto, Toronto, Ontario, Canada
  7. 7Department of Emergency Medicine, Washington University in Saint Louis, Saint Louis, Missouri, USA
  8. 8Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
  1. Correspondence to Sangil Lee; sangil-lee{at}uiowa.edu

Abstract

Introduction Delirium 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 analysis Searches 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 dissemination This 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 number CRD42020169654.

  • accident & emergency medicine
  • geriatric medicine
  • delirium & cognitive disorders
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2020-037915

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    Footnotes

    • Twitter @kagocchi28

    • Contributors EBD is the first and SL is the corresponding author; EBD, CC and SL conceived and designed the study; HH designed the draft search strategy; SL, MK, JHH, JL, GA will acquire data; SL will analyse and interpret data; EBD and SL drafted the initial and final protocol; MK, JHH, JL, GA, CC, HH and SL performed critical revisions of the protocol. All authors approved the final version of the protocol.

    • Funding This study was supported by the departmental seed funding by the Department of Emergency Medicine at the University of Iowa Hospitals and Clinics. The protocol was not influenced by the funding source. Award/Grant number is not applicable.

    • Competing interests CC: conflicts include SAEM Board of Directors, Geriatric Emergency Care Applied Research Network investigator leading cognitive impairment core, Clinician-Scientists Transdisciplinary Aging Research Leadership Core, Academic Emergency Medicine Deputy Editor-in-Chief, Journal of the American Geriatrics Society Associate Editor, Schwartz-Reisman Emergency Medicine Institute International Advisory Board Chair, and American Board of Emergency Medicine MyEMCert Editor.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.