Delirium Bibliography

**The Delirium Bibliography is moving!**

 

We're excited to announce that the Delirium Bibliography has been moved to the Network for Investigation of Delirium: Unifying Scientists (NIDUS) website! The new bibliography includes well over 3,000 references on delirium and acute care for elders in addition to new references on pediatric delirium, as well. Articles in the new bibliography are still indexed by keywords taken from MEDLINE and other relevant databases, and they can be easily browsed with a search function. Questions? Email margaretwebb@hsl.harvard.edu

The searchable delirium bibliography page is one of our most popular features, allowing you to quickly gain access to the literature on delirium and acute care of older persons.  The HELP team keeps it updated for you on a monthly basis!  Feel free to search by author, title, keywords. It is primarily intended for clinicians and researchers interested in exploring these topics.

Each article is indexed by keywords taken from MEDLINE and other relevant databases.

You may base your search on as many search terms as you like. A search term can be a keyword, an author's name, all or part of an article's title, or any word or phrase that you might expect to find in an article's abstract. You may then indicate whether you would like to limit the search to one or more options.

The results are prioritized so that entries including all search terms will be listed first, but you can indicate whether to then sort by title (the default), by author, by journal name or by publication year.

You may further restrict to a topic category. Note: If you do not enter any search terms, the results will include all of the entries for the selected topic category.

More information about each entry on this page is available by moving the mouse over the green information symbols.

Please note that Pub Med Central (PMC) full text links are provided wherever available.  However, due to copyright restrictions, only abstracts can be provided for articles not available in PMC.

Total Results: 3263

  • Effect of Perioperative Low-Dose Dexmedetomidine on Postoperative Delirium After Living-Donor Liver Transplantation: A Randomized Controlled Trial. 2019 Lee, H. Yang, S. M. Chung, J. Oh, H. W. Yi, N. J. Suh, K. S. Oh, S. Y. Ryu, H. G.. Transplant Proc,
    • Title

      Effect of Perioperative Low-Dose Dexmedetomidine on Postoperative Delirium After Living-Donor Liver Transplantation: A Randomized Controlled Trial.

    • Authors
      Lee, H. Yang, S. M. Chung, J. Oh, H. W. Yi, N. J. Suh, K. S. Oh, S. Y. Ryu, H. G.
    • Year
      2019
    • Journal
      Transplant Proc
    • URL
    • Abstract
      BACKGROUND: Postoperative delirium after liver transplantation (LT) is associated with increased hospital length of stay and higher morbidity and mortality. Dexmedetomidine is a recommended and widely used sedative in critically ill patients with reports of potential for delirium prevention. METHODS: A randomized controlled clinical trial was performed to investigate whether perioperative low-dose dexmedetomidine infusion would decrease delirium after living-donor LT. Dexmedetomidine (0.1 mcg/kg/hour) was administered during anesthesia and through postoperative day 2 for patients in the dexmedetomidine group, whereas 0.9% saline was administered at the same rate for the same duration for patients in the control group. The incidence of delirium after LT was compared between the 2 groups. Delirium duration, mechanical ventilation duration, intensive care unit (ICU) and hospital length of stay, and in-hospital and 3-month mortality were also compared. RESULTS: There was no significant difference in delirium incidence in the dexmedetomidine group compared to the control group (9% vs 5.9%; P = .44). Duration of delirium and mechanical ventilation, ICU and hospital length of stay, and in-hospital and 3-month mortality were comparable between the 2 groups. CONCLUSIONS: Perioperative low-dose dexmedetomidine infusion did not reduce the incidence of delirium in living-donor LT.
    • PubMed ID
  • The Association of Perioperative Serum Lactate Levels with Postoperative Delirium in Elderly Trauma Patients. 2019 Lee, C. Lee, J. Cho, H. Song, J. Jung, H. Ma, X. Hwang, J.. Biomed Res Int,
    • Title

      The Association of Perioperative Serum Lactate Levels with Postoperative Delirium in Elderly Trauma Patients.

    • Authors
      Lee, C. Lee, J. Cho, H. Song, J. Jung, H. Ma, X. Hwang, J.
    • Year
      2019
    • Journal
      Biomed Res Int
    • URL
    • Abstract
      Background. Several studies have shown the utility of lactate level as a predictor of early outcomes in trauma patients. We conducted this study to evaluate the association of perioperative serum lactate levels with postoperative delirium (POD) in elderly trauma patients. Materials and Methods. This study included 466 elderly trauma patients with measurements of serum lactate levels on admission and 1 h after surgery. The associations of POD with serum lactate levels (on admission and 1 h after surgery) and lactate clearance were analyzed using Kendall's correlation. Perioperative serum lactate levels and lactate clearance as predictors of POD were evaluated using univariate and multivariable analyses. Results. The incidence of POD in the present study was 38.1%. Serum lactate levels on admission and at 1 h after surgery were significantly higher in major trauma than in minor trauma. In univariate analysis of perioperative serum lactate levels and lactate clearance as predictors of POD, the odds ratio (OR) for serum lactate level on admission was 4.19 (P<0.01, 2.91 < 95% confidence interval (CI) < 6.02) and that 1 h after surgery was 3.83 (P<0.01, 2.79 < 95% CI < 5.25); however, the OR for serum change of lactate level was 0.99 ((P<0.09, 0.99 < 95% CI < 1.00). In multivariable analysis for predictors of POD, the OR for serum lactate level on admission was 2.40 (P<0.09, 0.87 < 95% CI < 6.7), that for serum lactate 1 h after surgery was 2.83 (P=0.01, 1.28 < 95% CI < 6.24), that for ICU admission was 3.01 (P=0.01, 2.09 < 95% CI < 6.03), and that for ISS was 1.47 (P<0.01, 1.27 < 95% CI < 3.70). Conclusions. Taking together the results of univariate and multivariable analyses, serum lactate level 1 h after surgery may be used as a prediction model of POD development in elderly trauma patients.
    • PubMed ID
  • Frailty defined by 19 items as a predictor of short-term functional recovery in patients with hip fracture. 2019 Inoue, T. Misu, S. Tanaka, T. Kakehi, T. Kakiuchi, M. Chuman, Y. Ono, R.. Injury, 50:12 (2272-6)
    • Title

      Frailty defined by 19 items as a predictor of short-term functional recovery in patients with hip fracture.

    • Authors
      Inoue, T. Misu, S. Tanaka, T. Kakehi, T. Kakiuchi, M. Chuman, Y. Ono, R.
    • Year
      2019
    • Journal
      Injury
    • URL
    • Abstract
      Introduction: Many hip fracture patients have decreased functional status inhibiting recovery to pre-fracture functional status. The prevalence of frailty in patients with hip fracture is high, but little is known how frailty is associated with functional recovery. The aim of this study was to determine whether frailty can predict functional recovery and clinical outcomes during the acute phase in hip fracture. Patients and Methods: This study was retrospective observational study from two acute hospitals. Participants were recruited from hip fracture patients who underwent surgery. The main exposure was frailty defined using 19-item modified Frailty Index (mFI). The main outcome was functional recovery, evaluated by postoperative efficiency on the motor-Functional Independence Measure (FIM) score. Secondary outcomes included postoperative complication and discharge disposition. Multiple logistic regression analyses were performed using each outcome as a dependent variable and mFI as an independent variable. Results: Sample included 274 patients (mean age 83.7 ± 7.4 years, female 80.7%). Patients with higher mFI exhibited lower functional recovery, defined by efficiency on the motor-FIM score, and tended to run into complications and not return home (P <.001). In multiple logistic regression analyses, higher mFI was significantly associated with increased likelihood of lower functional recovery (odds ratio [OR], 1.60; 95% CI, 1.32–1.93; P <.001), occurrence of postoperative complication (OR, 1.32; 95% CI, 1.13–1.54; P <.001) and not returning home (OR, 1.77; 95% CI, 1.38–2.26; P <.001). Conclusions: Frailty defined by 19-item mFI can predict short-term functional recovery during acute phase following hip fracture. Frailty is also associated with postoperative complication and discharge disposition.
    • PubMed ID
  • Using language descriptors to recognise delirium: a survey of clinicians and medical coders to identify delirium-suggestive words. 2019 Holmes, N. E. Amjad, S. Young, M. Berlowitz, D. J. Bellomo, R.. Crit Care Resusc, 21:4 (299-302)
    • Title

      Using language descriptors to recognise delirium: a survey of clinicians and medical coders to identify delirium-suggestive words.

    • Authors
      Holmes, N. E. Amjad, S. Young, M. Berlowitz, D. J. Bellomo, R.
    • Year
      2019
    • Journal
      Crit Care Resusc
    • URL
    • Abstract
      OBJECTIVE: To develop a library of delirium-suggestive words. DESIGN: Cross-sectional survey. SETTING: Single tertiary referral hospital. PARTICIPANTS: Medical, nursing and allied health staff and medical coders. MAIN OUTCOME MEASURES: Frequency of graded response on a 5-point Likert scale to individual delirium-suggestive words. RESULTS: Two-hundred and three complete responses were received from 227 survey respondents; the majority were medical and nursing staff (42.4% and 43.8% respectively), followed by allied health practitioners and medical coders (10.3% and 3.4%). Words that were "very likely" to suggest delirium were "confused/ confusion", "delirious", "disoriented/disorientation" and "fluctuating conscious state". Differences in word selection were noted based on occupational background, prior knowledge of delirium, and experience in caring for intensive care unit patients. Distractor words included in the survey were rated as "unlikely" or "very unlikely" by respondents as expected. Textual responses identified several other descriptors of delirium-suggestive words. CONCLUSION: A comprehensive repertoire of delirium-suggestive words was validated using a multidisciplinary survey and new words suggested by respondents were added. The use of natural language processing algorithms may allow for earlier detection of delirium using our delirium library and be deployed for real-time decision making and clinical care.
    • PubMed ID
  • Diagnostic test accuracy meta-analysis of PRE-DELIRIC (PREdiction of DELIRium in ICu patients): A delirium prediction model in intensive care practice. 2019 Ho, M. H. Chen, K. H. Montayre, J. Liu, M. F. Chang, C. C. Traynor, V. Shen Hsiao, S. T. Chang, H. R. Chiu, H. Y.. Intensive Crit Care Nurs,
    • Title

      Diagnostic test accuracy meta-analysis of PRE-DELIRIC (PREdiction of DELIRium in ICu patients): A delirium prediction model in intensive care practice.

    • Authors
      Ho, M. H. Chen, K. H. Montayre, J. Liu, M. F. Chang, C. C. Traynor, V. Shen Hsiao, S. T. Chang, H. R. Chiu, H. Y.
    • Year
      2019
    • Journal
      Intensive Crit Care Nurs
    • URL
    • Abstract
      OBJECTIVES: To review and examine the evidence on diagnostic test accuracy of PRE-DELIRIC (PREdiction of DELIRium in ICu patients) for predicting delirium risk in critically ill patients. RESEARCH METHODOLOGY: This meta-analysis included studies reporting the diagnostic performance of PRE-DELIRIC between 2012 and 2019. The Cochrane Library, MEDLINE, Embase, CINAHL and Chinese Electronic Periodical Services databases were searched for eligible diagnostic studies. Risk of bias was assessed using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. RESULTS: We included seven studies involving a total of 7941 critically ill patients in intensive care units settings. Results indicated that PRE-DELIRIC had a summary sensitivity of 0.76 (95% CI 0.60-0.87), and specificity of 0.66 (95% CI 0.45-0.82), suggesting that diagnostic performance of PRE-DELIRIC is useful to predict delirium risk in ICU patients. The area under the summary receiver operator characteristics (SROC) curve was 0.78 (95% CI 0.74-0.81), which also confirmed good accuracy of PRE-DELIRIC. CONCLUSION: We suggest that the PRE-DELIRIC model can be applied in the intensive care unit according to its good diagnostic test accuracy. However, this finding should be interpreted with caution due to the heterogeneity of this meta-analysis.
    • PubMed ID
  • Delirium post-cardiac surgery: Incidence and associated factors. 2019 Habeeb-Allah, A. Alshraideh, J. A.. Nurs Crit Care,
    • Title

      Delirium post-cardiac surgery: Incidence and associated factors.

    • Authors
      Habeeb-Allah, A. Alshraideh, J. A.
    • Year
      2019
    • Journal
      Nurs Crit Care
    • URL
    • Abstract
      BACKGROUND: Post-operative delirium among cardiac surgery patients is a prevalent complication that associated with multiple negative outcomes. AIMS AND OBJECTIVES: This study aimed to assess delirium incidence, associated factors, and outcomes for adult patients who underwent elective cardiac surgery. DESIGN: An exploratory prospective cohort design was used for this study. METHODS: Delirium was diagnosed by the Confusion Assessment Method for the Intensive Care Unit. Incidence, preoperative, intraoperative, and post-operative variables for 245 patients during 3-month period were collected and analysed. RESULTS: Delirium developed in 9% (n = 22) of the sample. Patients with delirium were significantly older (mean age = 65.7, SD = 8.1), t (243) = -3.66, P < .05); had longer surgery time (mean time = 286.3, SD = 82.2), t (243) = -2.25, P < .05); received more blood post-surgery (t (243) = -3.86, P < .05); spent more time on mechanical ventilation (t [21.6] = -2.2, P < .05); had longer critical care unit stay (t [21.7] = -4.0, P < 0.05); and had longer hospitalization than patients without delirium. CONCLUSIONS: The risk factors associated with development of delirium were advanced age and increased duration of surgery. Negative outcomes associated with delirium were increased duration of mechanical ventilation, increased volume of post-operative infused colloids and blood/products, increased critical care unit stay, and increased hospitalization. A multifactorial model for delirium risk factors should be considered to detect and work on potentially preventable delirium factors. RELEVANCE TO CLINICAL PRACTICE: Post-cardiac surgery delirium leads to longer mechanical ventilation time, increased ICU stay, and prolonged hospitalization. Delirium post-cardiac surgery is potentially preventable with appropriate identification of risk factors by nurses.
    • PubMed ID
  • EEG Correlates of Delirium in Children and Young Adults With CD19-Directed CAR T Cell Treatment-Related Neurotoxicity. 2019 Gust, J. Annesley, C. E. Gardner, R. A. Bozarth, X.. J Clin Neurophysiol,
    • Title

      EEG Correlates of Delirium in Children and Young Adults With CD19-Directed CAR T Cell Treatment-Related Neurotoxicity.

    • Authors
      Gust, J. Annesley, C. E. Gardner, R. A. Bozarth, X.
    • Year
      2019
    • Journal
      J Clin Neurophysiol
    • URL
    • Abstract
      INTRODUCTION: EEG patterns in chimeric antigen receptor T cell treatment-associated neurotoxicity (immune effector cell-associated neurotoxicity syndrome) have not yet been systematically studied. We tested the hypothesis that EEG background abnormalities in immune effector cell-associated neurotoxicity syndrome correlate with clinical signs of neurotoxicity. In addition, we describe ictal and interictal EEG patterns to better understand the natural history of immune effector cell-associated neurotoxicity syndrome-associated seizures. METHODS: EEGs were obtained in 19 of 100 subjects in a prospective cohort study of children and young adults undergoing CD19-directed chimeric antigen receptor T cell therapy. We classified the EEG background on a severity scale of 0 to 5 during 30-minute epochs. EEG grades were compared with neurotoxicity scored by Common Terminology Criteria for Adverse Events and Cornell Assessment of Pediatric Delirium scores. Descriptive analysis was conducted for ictal and interictal EEG abnormalities. RESULTS: EEG background abnormality scores correlated well with Common Terminology Criteria for Adverse Events neurotoxicity scores (P = 0.0022) and Cornell Assessment of Pediatric Delirium scores (P = 0.0085). EEG was better able to differentiate the severity of coma patterns compared with the clinical scores. The EEG captured electroclinical seizures in 4 of 19 subjects, 3 of whom had additional electrographic-only seizures. Seizures most often arose from posterior head regions. Interictal epileptiform discharges were focal, multifocal, or lateralized periodic discharges. No seizures or interictal epileptiform abnormalities were seen in subjects without previous clinical seizures. CONCLUSIONS: Continuous EEG monitoring is high yield for seizure detection in high-risk chimeric antigen receptor T cell patients, and electrographic-only seizures are common. Increasing severity of EEG background abnormalities correlates with increasing neurotoxicity grade.
    • PubMed ID
  • Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study. 2019 Godfrey, M. Green, J. Smith, J. Cheater, F. Inouye, S. K. Hurst, K. Young, J.. BMC Geriatr, 20:1
    • Title

      Process of implementing and delivering the Prevention of Delirium system of care: a mixed method preliminary study.

    • Authors
      Godfrey, M. Green, J. Smith, J. Cheater, F. Inouye, S. K. Hurst, K. Young, J.
    • Year
      2019
    • Journal
      BMC Geriatr
    • URL
    • Abstract
      BACKGROUND: Delirium is a frequent complication of hospital admission among older people. Multicomponent interventions which can reduce incident delirium by approximately one-third are recommended by the National Institute of Health and Care Excellence. Currently, a standardised delirium prevention system of care suitable for adoption in the UK National Health Service does not exist. The Prevention of Delirium (POD) system of care is a theory informed, multicomponent intervention and systematic implementation process which includes a role for hospital volunteers. We report POD implementation and delivery processes in NHS hospital wards, as part of a feasibility study. METHODS: A comparative case study design and participatory, multi-method evaluation was performed with sequential six month preparatory and six month delivery stages. Six wards in five hospitals in Northern England were recruited. Methods included: facilitated workshops; observation of POD preparatory activities; qualitative interviews with staff; collection of ward organisational and patient profiles; and structured observation of staff workload. RESULTS: POD implementation and delivery was fully accomplished in four wards. On these wards, implementation strategies informed by Normalization Process Theory operated synergistically and cumulatively. An interactive staff training programme on delirium and practices that might prevent it among those at risk, facilitated purposeful POD engagement. Observation of practice juxtaposed to action on delirium preventive interventions created tension for change, legitimating new ways of organising work around it. Establishing systems, processes and documentation to make POD workable in the ward setting, enhanced staff ownership. 'Negotiated experimentation' to involve staff in creating, appraising and modifying systems and practices, helped integrate the POD care system in ward routines. Activating these change mechanisms required a particular form of leadership: pro-active 'steer', and senior ward 'facilitator' to extend 'reach' to the staff group. Organisational discontinuity (i.e. ward re-location and re-modelling) disrupted and extended POD implementation; staff shortages adversely affected staff capacity to invest in POD. Findings resulted in the development of 'site readiness' criteria without which implementation of this complex intervention was unlikely to occur. CONCLUSIONS: POD implementation and delivery is feasible in NHS wards, but a necessary context for success is 'site readiness.'
    • PubMed ID
  • Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery. 2019 Eertmans, W. De Deyne, C. Genbrugge, C. Marcus, B. Bouneb, S. Beran, M. Fret, T. Gutermann, H. Boer, W. Vander Laenen, M. Heylen, R. Mesotten, D. Vanelderen, P. Jans, F.. Br J Anaesth,
    • Title

      Association between postoperative delirium and postoperative cerebral oxygen desaturation in older patients after cardiac surgery.

    • Authors
      Eertmans, W. De Deyne, C. Genbrugge, C. Marcus, B. Bouneb, S. Beran, M. Fret, T. Gutermann, H. Boer, W. Vander Laenen, M. Heylen, R. Mesotten, D. Vanelderen, P. Jans, F.
    • Year
      2019
    • Journal
      Br J Anaesth
    • URL
    • Abstract
      BACKGROUND: Near-infrared spectroscopy non-invasively measures regional cerebral oxygen saturation. Intraoperative cerebral desaturations have been associated with worse neurological outcomes. We investigated whether perioperative cerebral desaturations are associated with postoperative delirium in older patients after cardiac surgery. METHODS: Patients aged 70 yr and older scheduled for on-pump cardiac surgery were included between 2015 and 2017 in a single-centre, prospective, observational study. Baseline cerebral oxygen saturation was measured 1 day before surgery. Throughout surgery and after ICU admission, cerebral oxygen saturation was monitored continuously up to 72 h after operation. The presence of delirium was assessed using the confusion assessment method for the ICU. Association with delirium was evaluated with unadjusted analyses and multivariable logistic regression. RESULTS: Ninety-six of 103 patients were included, and 29 (30%) became delirious. Intraoperative cerebral oxygen saturation was not significantly associated with postoperative delirium. The lowest postoperative cerebral oxygen saturation was lower in patients who became delirious (P=0.001). The absolute and relative postoperative cerebral oxygen saturation decreases were more marked in patients with delirium (13 [6]% and 19 [9]%, respectively) compared with patients without delirium (9 [4]% and 14 [5]%; P=0.002 and P=0.001, respectively). These differences in cerebral oxygen saturation were no longer present after excluding cerebral oxygen saturation values after patients became delirious. Older age, previous stroke, higher EuroSCORE II, lower preoperative Mini-Mental Status Examination, and more substantial absolute postoperative cerebral oxygen saturation decreases were independently associated with postoperative delirium incidence. CONCLUSIONS: Postoperative delirium in older patients undergoing cardiac surgery is associated with absolute decreases in postoperative cerebral oxygen saturation. These differences appear most detectable after the onset of delirium. CLINICAL TRIAL REGISTRATION: NCT02532530.
    • PubMed ID
  • A systematic review and meta-analysis evaluating geriatric consultation on older trauma patients. 2019 Eagles, D. Godwin, B. Cheng, W. Moors, J. Figueira, S. Khoury, L. Fournier, K. Lampron, J.. J Trauma Acute Care Surg,
    • Title

      A systematic review and meta-analysis evaluating geriatric consultation on older trauma patients.

    • Authors
      Eagles, D. Godwin, B. Cheng, W. Moors, J. Figueira, S. Khoury, L. Fournier, K. Lampron, J.
    • Year
      2019
    • Journal
      J Trauma Acute Care Surg
    • URL
    • Abstract
      BACKGROUND: Early involvement of geriatrics is recommended for older trauma patients. OBJECTIVE: This systematic review aimed to determine the impact of a geriatric assessment on mortality, hospital length of stay, discharge destination and delirium incidence in patients 65 years and older admitted to a trauma centre. METHODS: The protocol was developed according to PRISMA guidelines and registered in PROSPERO (CRD42019131870). Search of five databases was completed April 2019. Two independent reviewers completed screening, full text review and data abstraction. Meta-analysis was performed on outcomes with at least two studies. RESULTS: 928 unique citations were identified; eight were included in the final analysis. All were cohort studies, most of moderate to poor quality using the Newcastle Ottawa Scale. We found hospital length of stay decreased by mean 1.11 days (95% CI 0.79 to 1.43) but mortality was unchanged OR 1.01 (95% CI 0.74 to 1.38) in older patients admitted to a trauma centre who had a geriatric consultation. Meta-analysis of discharge destination and delirium incidence was not performed due to heterogeneity. CONCLUSIONS: This is the first systematic review and meta-analysis to evaluate outcomes in older patients admitted to a trauma centre after implementation of a geriatric trauma consultation service. We found a decrease in hospital length of stay but insufficient evidence of change in in-hospital mortality in older patients who received a geriatric consultation as part of their trauma care compared with those that received standard trauma care only. There is a need for more methodologically rigorous research in geriatric trauma. LEVEL OF EVIDENCE: Systematic review and meta-analysis, level 3.
    • PubMed ID
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