Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA.
BMJ Open. 2020 Jul 20;10(7):e039175. doi: 10.1136/bmjopen-2020-039175.
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.
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.
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.CDR42020175261.
在急诊科（ED）就诊的老年人中，谵妄常常被漏诊。尽管目前推荐在 ED 中主动筛查谵妄，但这可能不可行或不切实际。在 ED 中识别出患有普遍和新发谵妄的高风险患者将有助于改善筛查过程并建立干预措施。目前，关于 ED 中与谵妄相关的危险因素的证据分散。为了解决这一差距，我们正在进行一项系统评价，以描述 ED 中谵妄的危险因素（患者脆弱性因素和诱发因素）。
从 Ovid EBM Reviews、Ovid EMBASE、Ovid MEDLINE、Scopus 和 Web of Science 中进行了从成立到 2020 年 3 月的文献检索。我们将包括原始研究报告，这些研究报告报告了 ED 环境中至少一个危险因素与谵妄之间的定量关系。两名调查员将使用本方案中的纳入标准独立筛选标题和摘要，并根据可能纳入研究的全文审查选择研究。在最终确定纳入的研究后，两名调查员将使用标准化的数据收集表提取数据。如果合适，将通过随机效应荟萃分析汇总每个危险因素的数据。将使用推荐评估、制定和评估方法来评估证据的总体质量。
据我们所知，这将是第一项专门评估与 ED 环境相关的普遍和新发谵妄特定危险因素的系统评价。本研究的结果将有助于识别 ED 中患有谵妄风险的老年人。我们的目标是在具有急诊医学和老年医学领域良好可见度的同行评审期刊上发表这项系统评价的结果。CDR42020175261。
