College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Health Sciences Division, University of Warwick, Coventry, UK.
Int J Clin Pract. 2021 Jul;75(7):e13859. doi: 10.1111/ijcp.13859. Epub 2021 Jan 15.
Delirium is an acute condition that occurs in hospitalised patients and leads to poor patient outcomes that can last long term. Therefore, the importance of prevention is undeniable and adopting new models of care for at-risk patients should be prioritised.
This systematic review and meta-analysis will assess the effectiveness of different interventions designed to prevent or manage delirium in acutely unwell hospitalised patients.
MEDLINE, EMBASE, PsycINFO, OpenGrey, Web of Science and reference lists of journals were searched. Eligible studies reported on incidence or duration of delirium, used a validated delirium diagnostic tool and compared an intervention to either a control or another intervention group. Meta-analyses were conducted, and GRADEpro software was used to assess the certainty of evidence. This review is registered on PROSPERO.
A total of 59 studies were included and 33 were eligible for meta-analysis. Delirium incidence was most significantly reduced by non-pharmacological multicomponent interventions compared with usual care, with pooled risk ratios of 0.57 (95% CI: 0.44 to 0.73, 10 randomised controlled trials) and 0.47 (95% CI: 0.35 to 0.64, six observational studies). Single-component interventions did not significantly reduce delirium incidence compared with usual care in seven randomised trials (risk ratio = 0.92, 95% CI: 0.81 to 1.04). The most effective single-component intervention in reducing delirium incidence was a hospital-at-home intervention (risk ratio = 0.29, 95% CI: 0.09 to 0.87).
Non-pharmacological multicomponent interventions are effective in preventing delirium; however, the same cannot be said for other interventions because of uncertain results. There is some evidence that providing multicomponent interventions in patients' homes is more effective than in a hospital setting. Therefore, researching the benefits of hospital-at-home interventions in delirium prevention is recommended.
谵妄是一种发生在住院患者中的急性病症，可导致患者预后不良，且这种不良影响可能持续很长时间。因此，预防的重要性不言而喻，应优先采用新的护理模式来照顾高危患者。
本系统评价和荟萃分析将评估不同干预措施预防或管理急性病住院患者谵妄的效果。
检索 MEDLINE、EMBASE、PsycINFO、OpenGrey、Web of Science 和期刊参考文献。纳入的研究报告了谵妄的发生率或持续时间，使用了经过验证的谵妄诊断工具，并将干预措施与对照组或另一干预组进行了比较。进行了荟萃分析，并使用 GRADEpro 软件评估证据的确定性。本综述已在 PROSPERO 上注册。
共纳入 59 项研究，其中 33 项符合荟萃分析的纳入标准。与常规护理相比，非药物多组分干预措施可显著降低谵妄发生率，合并风险比为 0.57（95%CI：0.44 至 0.73，10 项随机对照试验）和 0.47（95%CI：0.35 至 0.64，6 项观察性研究）。与常规护理相比，7 项随机试验中的单一成分干预措施并未显著降低谵妄发生率（风险比=0.92，95%CI：0.81 至 1.04）。在降低谵妄发生率方面最有效的单一成分干预措施是医院居家干预（风险比=0.29，95%CI：0.09 至 0.87）。
非药物多组分干预措施可有效预防谵妄；然而，由于结果不确定，其他干预措施则不然。有一些证据表明，在患者家中提供多组分干预措施比在医院环境中更有效。因此，建议研究医院居家干预在预防谵妄方面的益处。
