GRADE-Based Clinical Practice Guidelines for Emergency Department Delirium Risk Stratification, Screening, and Brain...

Area of Science:

• Geriatric Emergency Medicine
• Delirium Management
• Evidence-Based Guidelines

Background:

• Delirium is a significant concern in older adults presenting to the emergency department (ED).
• Existing guidelines require updates based on current evidence for geriatric populations.

Purpose of the Study:

• To develop evidence-based recommendations for delirium management in the ED for older adults.
• To address risk stratification, diagnosis, and brain imaging in this population.

Main Methods:

• A multidisciplinary work group applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
• Evidence was assessed for certainty, and conditional recommendations were formulated.

Main Results:

• Six conditional recommendations were derived for delirium risk stratification, diagnosis, and imaging.
• Several tools (e.g., Delirium Risk Score, Zucchelli's, REDEEM, 4AT, bCAM, CAM-ICU, DTS) were evaluated with very low certainty of evidence.
• No recommendation for or against head CT for delirium evaluation in older ED patients due to insufficient evidence.

Conclusions:

• The current evidence base for delirium management in the ED is of very low certainty.
• Rigorous, ED-based research is essential to strengthen recommendations and improve care for older adults with delirium.