Christopher R Carpenter1, Nada Hammouda2, Elizabeth A Linton2,3, Michelle Doering4, Ugochi K Ohuabunwa5, Kelly J Ko6, William W Hung7,8, Manish N Shah9, Lee A Lindquist10, Kevin Biese11, Daniel Wei9, Libby Hoy12, Lori Nerbonne12, Ula Hwang13, Scott M Dresden14. 1. From the, Department of Emergency Medicine, Washington University in St. Louis School of Medicine, Emergency Care Research Core, St. Louis, MI, USA. 2. the, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. the, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. 4. the, Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, USA. 5. the, Division of General Medicine and Geriatrics, Emory University School of Medicine, Atlanta, GA, USA. 6. Clinical Research, West Health Institute, La Jolla, CA, USA. 7. James J. Peters VA Medical Center, Bronx, NY, USA. 8. and the, Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 9. the, BerbeeWalsh Department of Emergency Medicine, University of Wisconsin-Madison, Madison, WI, USA. 10. the, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. 11. the, Departments of Emergency Medicine and Internal Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 12. PFCC Partners, Long Beach, CA, USA. 13. the, Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, USA. 14. and the, Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Abstract
BACKGROUND: Older adult delirium is often unrecognized in the emergency department (ED), yet the most compelling research questions to overcome knowledge-to-practice deficits remain undefined. The Geriatric Emergency care Applied Research (GEAR) Network was organized to identify and prioritize delirium clinical questions. METHODS: GEAR identified and engaged 49 transdisciplinary stakeholders including emergency physicians, geriatricians, nurses, social workers, pharmacists, and patient advocates. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews, clinical questions were derived, medical librarian electronic searches were conducted, and applicable research evidence was synthesized for ED delirium detection, prevention, and management. The scoping review served as the foundation for a consensus conference to identify the highest priority research foci. RESULTS: In the scoping review, 27 delirium detection "instruments" were described in 48 ED studies and used variable criterion standards with the result of delirium prevalence ranging from 6% to 38%. Clinician gestalt was the most common "instrument" evaluated with sensitivity ranging from 0% to 81% and specificity from 65% to 100%. For delirium management, 15 relevant studies were identified, including one randomized controlled trial. Some intervention studies targeted clinicians via education and others used clinical pathways. Three medications were evaluated to reduce or prevent ED delirium. No intervention consistently prevented or treated delirium. After reviewing the scoping review results, the GEAR stakeholders identified ED delirium prevention interventions not reliant on additional nurse or physician effort as the highest priority research. CONCLUSIONS: Transdisciplinary stakeholders prioritize ED delirium prevention studies that are not reliant on health care worker tasks instead of alternative research directions such as defining etiologic delirium phenotypes to target prevention or intervention strategies.
BACKGROUND: Older adult delirium is often unrecognized in the emergency department (ED), yet the most compelling research questions to overcome knowledge-to-practice deficits remain undefined. The Geriatric Emergency care Applied Research (GEAR) Network was organized to identify and prioritize delirium clinical questions. METHODS: GEAR identified and engaged 49 transdisciplinary stakeholders including emergency physicians, geriatricians, nurses, social workers, pharmacists, and patient advocates. Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews, clinical questions were derived, medical librarian electronic searches were conducted, and applicable research evidence was synthesized for ED delirium detection, prevention, and management. The scoping review served as the foundation for a consensus conference to identify the highest priority research foci. RESULTS: In the scoping review, 27 delirium detection "instruments" were described in 48 ED studies and used variable criterion standards with the result of delirium prevalence ranging from 6% to 38%. Clinician gestalt was the most common "instrument" evaluated with sensitivity ranging from 0% to 81% and specificity from 65% to 100%. For delirium management, 15 relevant studies were identified, including one randomized controlled trial. Some intervention studies targeted clinicians via education and others used clinical pathways. Three medications were evaluated to reduce or prevent ED delirium. No intervention consistently prevented or treated delirium. After reviewing the scoping review results, the GEAR stakeholders identified ED delirium prevention interventions not reliant on additional nurse or physician effort as the highest priority research. CONCLUSIONS: Transdisciplinary stakeholders prioritize ED delirium prevention studies that are not reliant on health care worker tasks instead of alternative research directions such as defining etiologic delirium phenotypes to target prevention or intervention strategies.
Authors: E Rivers; B Nguyen; S Havstad; J Ressler; A Muzzin; B Knoblich; E Peterson; M Tomlanovich Journal: N Engl J Med Date: 2001-11-08 Impact factor: 91.245
Authors: Jin H Han; Nathan E Brummel; Rameela Chandrasekhar; Jo Ellen Wilson; Xulei Liu; Eduard E Vasilevskis; Timothy D Girard; Maria E Carlo; Robert S Dittus; John F Schnelle; E Wesley Ely Journal: Am J Geriatr Psychiatry Date: 2016-07-04 Impact factor: 4.105
Authors: Jin H Han; Amanda Wilson; Amy J Graves; Ayumi Shintani; John F Schnelle; E Wesley Ely Journal: Am J Emerg Med Date: 2016-03-03 Impact factor: 2.469
Authors: Simon R Yadgir; Collin Engstrom; Gwen Costa Jacobsohn; Rebecca K Green; Courtney M C Jones; Jeremy T Cushman; Thomas V Caprio; Amy J H Kind; Michael Lohmeier; Manish N Shah; Brian W Patterson Journal: J Am Geriatr Soc Date: 2021-10-13 Impact factor: 5.562
Authors: Jessica A Stanich; Lucas Oliveira J E Silva; Alexander D Ginsburg; Aidan F Mullan; Molly M Jeffery; Fernanda Bellolio Journal: Am J Emerg Med Date: 2021-10-30 Impact factor: 4.093
Authors: Anita N Chary; Noelle Castilla-Ojo; Christopher Joshi; Ilianna Santangelo; Christopher R Carpenter; Kei Ouchi; Aanand D Naik; Shan W Liu; Maura Kennedy Journal: J Am Geriatr Soc Date: 2021-12-06 Impact factor: 7.538
Authors: Nada Hammouda; Christopher R Carpenter; William W Hung; Adriane Lesser; Sylviah Nyamu; Shan Liu; Cameron J Gettel; Aaron Malsch; Edward M Castillo; Savannah Forrester; Kimberly Souffront; Samuel Vargas; Elizabeth M Goldberg Journal: Acad Emerg Med Date: 2021-06-15 Impact factor: 3.451
Authors: Katherine M Hunold; Elizabeth M Goldberg; Jeffrey M Caterino; Ula Hwang; Timothy F Platts-Mills; Manish N Shah; Tony Rosen Journal: Acad Emerg Med Date: 2021-09-28 Impact factor: 3.451
Authors: Lucas Oliveira J E Silva; Jessica A Stanich; Molly M Jeffery; Aidan F Mullan; Susan M Bower; Ronna L Campbell; Alejandro A Rabinstein; Robert J Pignolo; Fernanda Bellolio Journal: Acad Emerg Med Date: 2021-12-17 Impact factor: 5.221