Quality of clinical practice guidelines in delirium

Bush, S.H. et al. (2017) BMJ Open. 7:e013809

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Objective: To determine the accessibility and currency of delirium guidelines, guideline summary papers and evaluation studies, and critically appraise guideline quality.

 

Conclusions: Delirium guidelines are best sourced by a systematic grey literature search. Delirium guideline quality varied across all six AGREE II domains, demonstrating the importance of using a formal appraisal tool prior to guideline adaptation and implementation into clinical settings. Adding more knowledge translation resources to guidelines may improve their practical application and effective monitoring. More delirium guideline evaluation studies are needed to determine their effect on clinical practice.

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European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium

Aldecoa, C. et al. (2017) European Journal of Anaesthesiology. 34(4) pp. 192-214

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Postoperative delirium (POD) is an adverse postoperative complication that can occur in patients of any age, from children to the elderly. Its incidence varies in the various age groups and is substantially influenced by patient-related risk factors that are variably distributed and differentially accumulate in the different age groups. Elderly patients are generally thought to be at higher risk because predisposing risk factors such as cognitive impairment, comorbidity, sensorial deficits, malnutrition, polymedication, impaired functional status and frailty (a condition that can only be observed among aged patients) accumulate and overlap with ageing.

Moreover, POD (refer to the specific definition in the ‘Paediatric patients’ section) is a common complication in children of pre-school age (5 to 7 years): whether this is due to age-related psychological issues or to additional inflammatory effects on the brain cannot currently be determined. There is a limited number of studies on cognitive outcomes in children. For the USA, the Food and Drug Administration (FDA) recently recommended cautious indications for anaesthesia and surgery in children aged less than 3 years. In Europe, the ESA launched an initiative, the EUROpean Safe Tots Anaesthesia Research (Eurostar) Initiative Task Force to promote translational research on anaesthesia neurotoxicity and long-term outcomes after paediatric anaesthesia and surgery.

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Protocol Lacking for Post-op Delirium

While 70% of anesthesiologists say they “frequently” or “occasionally” encounter postoperative delirium in their practices, more than three-fourths (77%) lack a process to screen for at-risk patients | Anesthesiology News

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A survey of nearly 300 anesthesiologists revealed that postoperative delirium is extraordinarily common worldwide, with 95% of respondents reporting they have had such a patient. However, 60% said they did not commonly discuss possible neurologic complications with their patients prior to surgery. In addition, 84% said their hospital or clinic did not have protocols to prevent postoperative delirium and 73% said their facility lacked protocols to manage delirium when it occurred. Of anesthesiologists without a screening process, 88% said they would consider implementing one.

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