Delirium Guidelines

Updated: Apr 25, 2019
  • Author: Kannayiram Alagiakrishnan, MD, MBBS, MPH, MHA; Chief Editor: Glen L Xiong, MD  more...
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Guidelines

Guidelines Summary

Scottish Intercollegiate Guidelines Network

Guidelines for risk reduction and management of delirium were published by the Scottish Intercollegiate Guidelines Network (SIGN) in March 2019. [74]

Detecting delirium

Use the 4 As Test (Arousal, Attention, Abbreviated Mental Test 4 [AMT4], Acute change) for identifying patients with probable delirium in emergency and acute hospital settings. This tool may also be used in community or other settings.

In the ICU setting, use the Confusion Assessment Method for the ICU (CAM-ICU) or the Intensive Care Delirium Screening Checklist (ICDSC) to identify patients with probable delirium.

Use CT brain scan in those patients presenting with delirium in the presence of the following:

  • New focal neurological signs
  • Reduced level of consciousness
  • A history of falls
  • Head injury
  • Anticoagulation therapy

Consider an electroencephalogram when there is suspicion of epileptic activity or non-convulsive status epilepticus.

Reducing risk of delirium

Consider all of the following as part of a package of care for patients at risk for delirium:

  • Ensuring patients have their glasses and hearing aids, if applicable
  • Promoting sleep hygiene
  • Early mobilization
  • Pain control
  • Prevention, early identification, and treatment of post-operative complications
  • Maintaining optimal hydration and nutrition
  • Regulation of bladder and bowel function
  • Provisions of supplementary oxygen, if appropriate

Monitor depth of anesthesia in patients 60 years of age and over undergoing surgery that is expected to last more than 1 hr.

Treating delirium

Consider acute, life-threatening causes of delirium. These may include low oxygen level, low blood pressure, low glucose level, and drug intoxication or withdrawal.

Identify and treat potential causes such as medications and acute illness. Multiple causes are common.

Optimize physiology, environment, and medications to promote brain recovery.

Detect and treat agitation or distress with non-pharmacologic means, if possible.

Communicate diagnosis to patients and caregivers and provide ongoing support.

Attempt to prevent delirium complications such as immobility, falls, pressure sores, dehydration, malnourishment, and isolation.

Monitor patient recovery and refer to a specialist if necessary.