Table 2.
Overview of included studies
| Lead author, yeara |
Study design | Countryh | Age, mean (SD) | Male/female, N | Sample size | Delirium type | When/where delirium diagnosed |
Delirium diagnosis tool/s |
Subtype classification method/s |
|||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| All delirium | Hyper active | Hypo active | Mixed | No motor subtype | Combined | |||||||||
| Avelino-Silva, 2018 [44] | Prospective cohort | BR | 83.00 (8.00) | 250/407 | 657 | 112 | 348 | 197 | - | - | Prevalent | Geriatric ward admission/stay | Short CAM | Observation of clinical features |
| Balan, 2003 [56] | Prospective cohort | IL | 83.50 (7.10) | 13/18 | 31 | 7 | 10 | 14 | - | - | Incident | During medical ward stay | ICD-10 | Symptoms |
| Boettger, 2011ab [57] | Retrospective cohort | US | 69.60 (11.90) | 10/11 | 21 | 12 | 9 | - | - | - | Prevalent | Hospitalised cancer patients | DSM-IV, MDAS | NR |
| Boettger, 2011bb [58] | Retrospective cohort | US | 65.60 (13.60) | 65/46 | 111 | 61 | 50 | - | - | - | Prevalent | Cancer patients referred for delirium management |
DSM-IV-TR, MDAS | MDAS |
| Boettger, 2011cc [59] | Retrospective cohort | US | 58.36 (16.65) | 52/48 | 100 | - | 53 | - | - | 47 (hyper/mix) | Prevalent | Inpatients receiving cancer care | DSM-IV, MDAS | MDAS |
| Boettger, 2014b, c [60] | Retrospective cohort | US | 65.57 (13.71) | 65/46 | 111 | 62 | 49 | - | - | - | Prevalent | Patients undergoing cancer treatment referred for delirium management |
DSM-IV-TR, MDAS | NR |
| Boettger, 2017 [61] | Retrospective cohort | CH | 74.44 (10.74) | 63/28 | 91 | 11 | 38 | 42 | - | - | Prevalent | Medical and surgical referral patients |
DOS, S-CAM | DOS |
| Bui, 2017 [62] | Retrospective cohort | US | 65.00 (16.00) | 214/209 | 423 | - | 170 | - | - | 253 (hyper/mix) | Prevalent | During surgical ICU stay | CAM-ICU, ICD-9-CM | RASS |
| Camus, 2000 [63] | Prospective cohort | FR, CH | 84.10 (5.90) | 63/120 | 183 | 85 | 48 | 50 | - | - | Prevalent | Admission to geriatric ward | DSM-III-R | Symptom checklist |
| Chong, 2013d [64] | Prospective cohort | SG | 84.20 (7.40) | 99/129 | 228 | 117 | 42 | 69 | - | - | Prevalent | Geriatric Admission Unit (admission or during hospital stay) |
CAM | Activity pattern |
| Chong, 2015d [65] | Prospective cohort | SG | 84.13 (7.36) | 102/132 | 234 | 121 | 46 | 67 | - | - | Prevalent | Admission to Geriatric Monitoring Unit |
CAM | Observation of psychomotor activity |
| Daly, 2018 [66] | Cross-sectional | IE | 79.10 (8.20) | 100/99 | 199 | 41 | 38 | 16 | 104 | - | Prevalent | Medical inpatients referred to consultation liaison psychiatry service |
DRS-R98, DSM-IV | NR |
| DeCrane, 2012 [67] | Prospective cohort | US | 89.95 (NR) | 71/249j | 70 | 14 | 33 | 23 | - | - | Prevalent | Long-term care residents during 28-day surveillance period |
CAM, NEECHAM, MMSE, Vigilance A test, CAC-A | CAC-A |
| Eriksson, 2002 [68] | Prospective cohort | SE | 72.50 (4.06) | 8/4 | 12 | 5 | 6 | 1 | - | - | Prevalent | During hospital stay for cardiac surgery (pre- or post-surgery) |
DSM-IV, CAM | Symptoms |
| Evensen, 2019ae [47] | Cross-sectional | NO | 86.70 (5.20) | 29/31 | 60 | 15 | 20 | 17 | 8 | - | Prevalent | NA | DSM-5 | DMSS |
| Evensen, 2019bh [69] | Prospective cohort | NO | 86.75 (5.19) | 43/50 | 93 | 27 | 30 | 24 | 12 | - | Prevalent | Geriatric ward (during hospital stay) |
DSM-5, chart-review, interviews with nurses | DMSS |
| Fialho Silva, 2021 [70] | Prospective cohort | BR | 67.99 (12.92) | 38/33 | 71 | 9 | 41 | 21 | - | - | Prevalent | Patients in acute phase of stroke admitted to Stroke Unit |
CAM | RASS |
| Franco, 2014 [71] | Case–control | CO | 78.30 (8.96) | 13/21 | 34 | 10 | 13 | 11 | - | - | Incident | Internal medicine ward stay | CAM-S, DRS-R98 | DRS-R98 |
| Glynn, 2021 [72] | Cross-sectional | IE, IN | 56.60 (20.30) | 1125/632 | 1757 | 844 | 298 | 426 | 189 | - | Prevalent | Patients in palliative care, old age liaison psychiatry and general adult liaison psychiatry settings | DSM-IV | DMSS-4 |
| Godfrey, 2009 [73] | Prospective cohort | IE | 70.70 (11.60) | 16/9 | 25 | 12 | 4 | 9 | - | - | Prevalent | Patients in palliative care | DSM-IV | DMC |
| Grover, 2014 [74] | Prospective cohort | IN | 49.00 (17.62) | 228/93 | 321 | 161 | 64 | 79 | 17 | - | Prevalent | Patients referred to psychiatry consultation liaison services from any medical or surgical ward |
DSM-IV-TR | DMSS |
| Gual, 2018 [16] | Prospective cohort | ES | 87.41 (6.00) | 140/203 | 343 | 143 | 91 | 109 | - | - | Prevalent | Admission to subacute care unit | CAM | DMSS |
| Hayhurst, 2020f [75] | Prospective cohort | US | 61.00 (13.34) | 343/239j | - | 100 | 411 | - | - | - | Prevalent | Adult medical and surgical ICU patients with respiratory failure or shock (during ICU stay) | CAM-ICU, RASS | RASS |
| Heymann, 2007 [76] | Retrospective cohort | DE | 64.00 (22.00) | 114/82 | 196 | 55 | - | - | - | - | Prevalent | Admission to anaesthesiology ICU or intermediate care unit |
DDS | DDS |
| Horacek, 2016 [77] | Prospective cohort | CZ | 68.21 (12.07) | 100/40 | 140 | 54 | 27 | 59 | - | - | Prevalent | Intensive care unit (during stay) | Validated chart review, Riker SAS, RASS | NR |
| Hughes, 2021f [78] | Prospective cohort | US | 63.00 (13.34) | 435/305 | 740 | 185 | 733 | - | - | - | Prevalent | Adult medical and surgical ICU patients with respiratory failure or shock (during ICU stay) | CAM-ICU, RASS | RASS |
| Jackson, 2017 [79] | Prospective cohort | GB | 85.50 (6.15) | 21/34 | 55 | 12 | 34 | 9 | - | - | Prevalent | Newly admitted medical patients | DSM-IV-TR, CAM, AMTS, digit span test, medical notes | DRS-R98 |
| Khurana, 2011 [80] | Prospective cohort | IN | 70.86 (8.86) | 224/176 | 400 | 102 | 259 | 39 | - | - | Prevalent | Medical ward (admission or during hospitalisation) |
DSM-IV, CAM | Symptoms |
| Kiely, 2007 [81] | RCT | US | 84.00 (7.30) | 162/295 | 457 | 47 | 212 | 55 | 143 | - | Prevalent | Admission to post-acute care | CAM | MDAS |
| Kim, 2018 [82] | Prospective cohort | KR | 69.30 (10.60) | 156/68 | 224 | 144 | 25 | 33 | 22 | - | Prevalent | Nonpsychiatric inpatients referred to the consultation liaison psychiatric service |
DSM-IV-TR, CAM | DMSS |
| Kobayashi, 1992 [83] | Prospective cohort | JP | 74.58 (9.47) | 63/43 | 106 | 83 | 7 | 16 | - | - | Prevalent | Referral to Division of Neuropsychiatry | NR | Clinical characteristics (Lipowski) |
| Kumar, 2015 [84] | Prospective cohort | IN | 33.78 (7.18) | 57/23 | 80 | 56 | 24 | - | - | - | Prevalent | Patients in psychiatry ward, general medical and surgical/postoperative wards and intensive care unit | DSM-IV-TR | MDAS |
| Lee, 2018 [85] | Prospective cohort | HK | 64.81 (NR) | 55/28 | 83 | 24 | 26 | 33 | - | - | Incident | Following urgent and elective cardiac surgery |
CAM-ICU | RASS |
| Leonard, 2011g [86] | Prospective cohort | IE | 70.30 (10.50) | 51/49 | 100 | 18 | 33 | 26 | 23 | - | Prevalent | Palliative care patients | CAM, DSM-IV | DMC |
| Liptzin, 1992 [87] | Prospective cohort | US | 86.10 (NR) | 47/78 | 125 | 19 | 24 | 65 | 17 | - | Prevalent | Admission for medical or surgical care (non-ICU), throughout stay |
DSM-III, DSI | DSI |
| Lixouriotis, 2011 [88] | Retrospective cohort | GR | 76.30 (8.00) | 5/4 | 9 | 6 | 1 | 2 | - | - | Prevalent | Patients examined at regional medical office |
ICD-10 | Clinical description (Liptzin and Levkoff) |
| Lundström, 2012 [89] | RCT | SE | 82.93 (6.15) | 36/93 | 129 | 56 | 43 | 28 | 2 | - | Incident | Following femoral neck fracture surgery | Modified OBS | NR |
| Marcantonio, 2002 [90] | Prospective cohort | US | 79.00 (8.00) | 9/39 | 49 | - | 34 | - | 1 | 14 (hyper/mix) | Incident | Following acute hip fracture surgery |
CAM | MDAS |
| Margiotta, 2006 [91] | Prospective cohort | IT | 81.60 (7.20) | 26/37 | 63 | 26 | 7 | 30 | - | - | Prevalent | Admission to acute medical care unit |
CAM | DRS, ODFS |
| Meagher, 2000 [92] | Prospective cohort | IE | 60.10 (19.50) | 20/26 | 46 | 14 | 11 | 21 | - | - | Prevalent | Referral from general medical wards to psychiatric consultation service |
ICD-10, DRS | Case records and information from the consultation |
| Meagher, 2012 [93] | Prospective cohort | IE | 70.20 (10.50) | 51/49 | 100 | 10 | 28 | 18 | 6 | - | Prevalent | Palliative care inpatients with cancer diagnoses |
DSM-IV | DMSS |
| Morandi, 2017 [94] | Cross-sectional | IT | 85.00 (6.70) | 113/162 | 275 | 59 | 106 | 75 | 35 | - | Prevalent | Patients in acute and rehabilitation hospital wards | 4AT | DMSS |
| Morandi, 2020 [95] | Cross-sectional | IT | 85.98 (NR) | 186/185 | 371 | 95 | 123 | 128 | 25 | - | Prevalent | Patients in acute and rehabilitation hospital wards | 4AT | DMSS |
| O’Keeffe, 1999 [96] | Prospective cohort | IE | 82.44 (4.63) | NR | 94 | 20 | 27 | 40 | 7 | - | Prevalent | Admission to acute care geriatric unit |
DSM-III, DAS | DAS |
| Özkul, 2019 [97] | Case–control | TR | 70.10 (13.60) | 29/24 | 53 | 34 | 14 | 5 | - | - | Prevalent | Admission to ICU | DSM-IV, CAM-ICU | NR |
| Park, 2016 [98] | Retrospective cohort | KR | 71.21 (13.16) | 132/78 | 210 | - | 67 | - | - | 143 (hyper/mix) | Prevalent | Referral from ward physicians to consultation liaison psychiatry service |
DRS-R98, CAM | RASS |
| Pasinska, 2019 [99] | Prospective cohort | PL | 77.47 (10.54) | 84/119 | 203 | 31 | 85 | 77 | 10 | - | Prevalent | Patients with stroke/TIA admitted to Stroke Unit |
bCAM, CAM-ICU, DSM-5 | DMSS-4 |
| Price, 2017 [100] | Prospective cohort | US | 70.50 (9.70) | 75/62 | 137 | 10 | 108 | 19 | - | - | Incident | Following elective cardiac surgery | CAM-ICU, RASS | RASS |
| Radinovic, 2019 [101] | Prospective cohort | RS | 80.95 (7.12) | NR | 148 | 37 | 111 | - | - | - | Incident | Following bipolar hemiarthroplasty or compression hip screw procedure |
CAM | Symptoms |
| Rawle, 2020 [102] | Retrospective cohort | GB | 86.00 (7.60) | 73/61j | 56 | 43 | 13 | - | - | - | Prevalent | Admission to hospital with COVID-19 diagnosis | Review medical records | Symptoms |
| Robinson, 2011 [44] | Prospective cohort | US | 69.11 (9.42) | 166/6j | 74 | 1 | 50 | 23 | - | - | Incident | Following elective operation with planned postoperative ICU admission |
CAM-ICU, validated medical record review | RASS |
| Rood, 2019 [103] | Retrospective cohort | NL | 64.64 (13.90) | 994/606 | 1,600 | 111 | 433 | 571 | - | - | Prevalent | Admission to ICU (during stay) | CAM-ICU, RASS | RASS |
| Santana Santos, 2005 [104] | Prospective cohort | SE | 82.90 (6.30) | 6/13 | 19 | 9 | 5 | 5 | - | - | Incident | Following operation for hip fracture |
CAM, DSM-IV | Classified according to Lipowski |
| Slor, 2013 [105] | Prospective cohort | NL | 85.75 (5.09) | 7/23 | 30 | 7 | 5 | 6 | 1 | - | Incident | Following surgery for hip fracture | CAM | DRS-R98 |
| Trzepacz, 2018g [106] | Cross-sectional | BR, CO, IE, JP, KR, TW, US | 68.00 (14.96) | 258/148 | 406 | 172 | 64 | 146 | 24 | - | Prevalent | During hospitalisation in general or rehabilitation hospital settings or referral to psychiatric services |
DSM-IV | DRS-R98 |
| van den Boogaard, 2012 [107] | Prospective cohort | NL | 64.00 (15.00) | 235/176 | 411 | 44 | 148 | 219 | - | - | Incident | During ICU stay | CAM-ICU, DOS | NR |
| van der Kooi, 2013 [108] | Retrospective cohort | NL | 66.71 (13.97) | 15/9 | 24 | 0 | 6 | 18 | - | - | Prevalent | During ICU stay | CAM-ICU, review of medical records | RASS |
| van Keulen, 2018 [109] | Prospective cohort | NL | 62.76 (14.24) | 257/153 | 410 | 0 | 124 | 286 | - | - | Prevalent | During ICU stay | CAM-ICU | RASS |
| van Velthuijsen, 2018 [110] | Retrospective cohort | NL | 81.00 (7.00) | 234/167 | 401 | - | 94 | - | - | 307 (hyper/mix) | Prevalent | During hospital admission | File review | Clinical judgement/DOS |
| Yang, 2019 [111] | Prospective cohort | KR | 77.58 (7.26) | 55/40 | 95 | 34 | 25 | 30 | 6 | - | Prevalent | Patients with cerebral infarction admitted to stroke unit (during stay) |
CAM | K-DMSS |
| Zipser, 2020 [112] | Prospective cohort | CH | 71.56 (13.88) | 379/223 | 602 | 72 | 229 | 301 | - | - | Prevalent | During hospital stay | DOS, S-CAM | DOS |
Note:-= Not applicable;
aReferences 68 and beyond are provided in Supplementary Materials.
b,c,d,e,f,g,Overlapping samples;
h2-digit ISO country code.
iSex reported for entire sample, not delirium only;
AMTS: Abbreviated Mental Test Score; bCAM: Abbreviated Confusion Assessment Method; CAC-A: Vermeersch Clinical Assessment of Confusion Form A; CAM: Confusion Assessment Method; CAM-ICU: Confusion Assessment Method for the Intensive Care Unit; CAM-S: Spanish Confusion Assessment Method; DAS: Delirium Assessment Scale; DMC: Delirium Motoric Checklist; DMSS: Delirium Motor Subtype Scale; DMSS-4: Abbreviated version of the Delirium Motor Subtype Scale; DOS: Delirium Observation Screening scale; DRS: Delirium Rating Scale; DRS-R98: Delirium Rating Scale – Revised-98; DSI: Delirium Symptom Interview; DSM-5: The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; DSM-III-R: The Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised; DSM-IV: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; DSM-IV-TR: The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; ICD-10: International Classification of Diseases, Tenth Revision; ICD-9-CM: International Classification of Diseases, Ninth Revision, Clinical Modification; ICU: intensive care unit; K-DMSS: Delirium Motor Subtype Scale, Korean Version; MDAS: Memorial Delirium Assessment Scale; MMSE: Mini-Mental State Examination; NEECHAM: The Neelon and Champagne Confusion Scale; NR: not reported; OBS: Organic Brain Syndrome Scale; ODFS: One Day Fluctuation Scale; RASS: Richmond Agitation Sedation Scale; Riker SAS: Riker Sedation-Agitation Scale; S-CAM: Short Confusion Assessment Method; TIA: transient ischemic attack.