Summary of findings 4. Prophylactic melatonin for preventing delirium in hospitalised non‐ICU patients.
| Prophylactic melatonin for preventing delirium in hospitalised non‐ICU patients | ||||||
| Intervention: Prophylactic melatonin versus placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Prophylactic melatonin | |||||
| Incidence of delirium CAM/DSM IV/DRS‐R‐9s Follow‐up: every 24 to 48 hours until discharge or 8 days | 242 per 10001 | 128 per 1000 (22 to 788) | RR 0.53 (0.09 to 3.25) | 529 (3 studies) | ⊕⊝⊝⊝ very low2,3,4 | |
| Duration of delirium Days Follow‐up: every 24 to 48 hours until discharge | The mean duration of delirium in the control group was 2 days |
The mean duration of delirium in the intervention groups was 0 days longer (0.57 shorter to 0.57 longer) | 104 (1 study) | ⊕⊕⊕⊝ moderate3 | ||
| Severity of delirium (binary severe vs. not severe) Number of patients requiring greater than 3mg of haloperidol Follow‐up: daily until discharge | 531 per 1000 | 457 per 1000 (308 to 674) | RR 0.86 (0.58 to 1.27) | 104 (1 study) | ⊕⊕⊕⊝ moderate3 | |
|
Severity of delirium DRS‐R‐98 score |
The mean severity of delirium in the control group was 6.3 points |
The mean severity of delirium in the intervention group was 4.1 points lower (19.47 points lower to 11.27 points higher) |
6 (1 study) |
⊕⊕⊝⊝ low5 | ||
| Length of admission Days | The mean length of admission in the control groups ranged from 11 to 18.5 days |
The mean length of admission in the intervention groups was 0.09 days longer (1.2 shorter to 1.39 longer) | 500 (2 studies) | ⊕⊕⊕⊝ moderate3 | ||
| Return to independent living ‐ not measured | N/A | N/A | N/A | N/A | ||
| In‐hospital mortality Mortality Follow‐up: every 24 to 48 hours until discharge or 8 days | 47 per 10001 | 39 per 1000 (17 to 88) | RR 0.84 (0.37 to 1.88) | 543 (3 studies) | ⊕⊕⊝⊝ low6 | |
| *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 The assumed risk is the risk in the control group
2 Downgraded because inconsistent results
3 Downgraded because imprecise results
4 Downgraded due to risk of bias
5 Downgraded because imprecise results and very small number of events