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Risk factors for delirium among older adults in the emergency department: a systematic review protocol
  1. Lucas Oliveira J e Silva1,
  2. Michelle J Berning1,2,
  3. Jessica A Stanich1,
  4. Danielle J Gerberi3,
  5. Jin Han4,5,
  6. Fernanda Bellolio1,6
  1. 1Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
  2. 2Medical School, University of Minnesota, Minneapolis, Minnesota, USA
  3. 3Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Department of Emergency Medicine, Vanderbilt University, Nashville, Tennessee, USA
  5. 5Geriatric Research, Education, and Clinical Center, VA Tennessee Valley Healthcare System Nashville Campus, Nashville, Tennessee, USA
  6. 6Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Lucas Oliveira J e Silva; lojesilva{at}


Introduction Delirium is commonly missed in older adults presenting to the emergency department (ED). Although current recommendations for active screening of delirium in the ED, this might not be feasible or practical. Identifying patients at high risk for prevalent and incident delirium in the ED will help to improve the screening process and to build interventions. There is currently scattered synthesis of evidence on risk factors associated with delirium in the ED. To address this gap, we are conducting a systematic review to describe the risk factors (patient vulnerability factors and precipitating factors) for delirium in the ED.

Methods and analysis A literature search was performed from inception to March 2020 in Ovid EBM Reviews, Ovid EMBASE, Ovid MEDLINE, Scopus and Web of Science. We will include original research studies that report a quantitative relationship between at least one risk factor and delirium in the ED setting. Two investigators will use eligibility criteria from this protocol to independently screen titles and abstracts, and select studies based on full-text review of potentially eligible studies. After arriving at a final set of included studies, two investigators will extract data using a standardised data collection form. If appropriate, data regarding each risk factor will be pooled through a random-effect meta-analysis. The Grading of Recommendations Assessment, Development and Evaluation approach will be used to evaluate the overall quality of evidence.

Ethics and dissemination To our knowledge, this will be the first systematic review evaluating risk factors for prevalent and incident delirium specifically related to the ED setting. Results of this study will aid in the identification of older adults at risk for delirium in the ED. We aim to publish the results of this systematic review in a peer-reviewed journal with good visibility for the fields of emergency medicine and geriatrics.

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  • delirium & cognitive disorders
  • geriatric medicine
  • protocols & guidelines
  • accident & emergency medicine

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:

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  • Twitter @lucasojesilva12, @mfbellolio

  • Contributors Conceptualisation: LOJeS and FB. Formal analysis: LOJeS and FB. Investigation: LOJeS, MJB, JAS, JH and FB. Literature search: DJG. Methodology: LOJeS and FB. Project administration: LOJeS. Supervision: FB. Validation: FB. Writing-original draft: LOJeS. Writing-review and editing: LOJeS, MJB, JAS, DJG, JH and FB. Guarantor: LOJeS and FB. All authors provided critical revision and contribution for important intellectual content.

  • Funding This study received funding through the Kern Society Innovation Award, from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The funders’ and authors’ institutions are not responsible for its content.

  • Competing interests None declared.

  • 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.

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