Summary of findings for the main comparison. A multi‐component delirium prevention intervention compared to usual care for hospitalised non‐ICU patients.
| Multi‐component delirium prevention intervention compared to usual care for hospitalised non‐ICU patients | ||||||
| Intervention: A multi‐component delirium prevention intervention versus usual care | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| A multi‐component delirium prevention intervention | ||||||
| Incidence of delirium validated instruments1 | 209 per 10002 | 144 per 1000 (123 to 172) | RR 0.69 (0.59 to 0.81) | 1950 (7 studies3) | ⊕⊕⊕⊝ moderate4,5,6 | |
| Duration of delirium (days) | The mean duration of delirium in the control groups ranged from 2.1 to 10.2 days | The mean duration of delirium in the intervention groups was 1.16 days shorter (2.96 shorter to 0.64 longer) | 244 (4 studies) | ⊕⊝⊝⊝ very low4,6,7,8,9 | ||
| Severity of delirium DRS‐R‐98 and CAM‐S10 | The standardised mean severity of delirium in the intervention groups was 1.04 standard deviations lower (1.65 to 0.43 lower)11 | 67 (2 studies) | ⊕⊕⊝⊝ low4,12 | |||
| Length of admission Days | The mean length of admission in the control groups ranged from 5 to 38 days | The mean length of admission in the intervention groups was 0.01 days longer (0.48 days shorter to 0.51 days longer) | 1920 (6 studies) | ⊕⊕⊕⊝ moderate4,6,7 | ||
| Return to independent living | 682 per 10002 | 648 per 1000 (580 to 723) | RR 0.95 (0.85 to 1.06) | 1116 (4 studies) | ⊕⊕⊕⊝ moderate4,6,13 | |
| Inpatient mortality | 81 per 10002 | 73 per 1000 (45 to 116) | RR 0.90 (0.56 to 1.43) | 859 (3 studies) | ⊕⊝⊝⊝ very low6,14,15 | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Three validated methods for delirium detection used ‐ the CAM, OBS and DRS 2 The assumed risk is the risk in the control group 3 Four studies in medical in patients, three studies in surgical patients 4 High risk of performance bias due to the lack of blinding of participants and personal in all studies (due to the nature of the intervention). 5 Outcomes assessors unblinded 2 studies (one of which carries the largest weighting (58%) due to high event rate). Risk of bias otherwise low across studies
6 Higher baseline prevalence of dementia in the control groups of two studies compared to the intervention groups causing risk of bias 7Outcomes assessors unblinded in two studies 8 Minimal important difference (MID) of 1 day assumed. 95% confidence limits around the pooled estimate of mean difference includes both 'no difference', and the MID.
9 Downgraded because inconsistent results
10 Delirium Rating Scale‐Revised‐98 (0 to 46) and Confusion Assessment Method‐Severity (0 to 10) 11This is a difference in standard deviations. A standard deviation of > 0.8 represents a large effect. 12 Imprecise results ‐ small pooled sample size 13 Outcomes assessors unblinded in one study 14There is some inconsistency of results 15Imprecise results ‐ pooled estimate includes both no effect, appreciable benefit and appreciable harm