Delirium: prevention, diagnosis and management in hospital and long-term care

Reasons for the decision

The majority of new evidence found supported the current guideline recommendations. New evidence was found on the use of ear plugs for sleep promotion and reducing delirium in hospitalised patients, however the current recommendations on sleep promotion were deemed to be sufficient.

A body of evidence was identified focusing on dexmedetomidine sedation for the prevention of post-operative delirium. The majority of studies compared dexmedetomidine with a placebo rather than other sedatives. One systematic review compared dexmedetomidine with propofol, midazolam and lorazepam and found no evidence for dexmedetomidine reducing delirium. As such further studies are required that compare dexmedetomidine with alternative sedatives before this area can be considered for inclusion in the guideline. Additionally, a screening tool, the 4 A's test, was highlighted by a stakeholder during consultation as an instrument used in units to screen people for delirium. We recognise this is an area of increasing interest and are aware of an NIHR study on the Development and validation of the 4AT tool. We are awaiting publication of this study so we can consider if there is an impact on the current recommendations when results are available.

For further details and a summary of all evidence identified in surveillance, see appendix A.