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Meta-Analysis
. 2020 Apr 27;49(3):352-360.
doi: 10.1093/ageing/afaa040.

The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study

Kate Gibb  1   2 , Anna Seeley  1   3 , Terry Quinn  4 , Najma Siddiqi  5 , Susan Shenkin  6 , Kenneth Rockwood  1   7 , Daniel Davis  1   2   3
Affiliations
Meta-Analysis

The consistent burden in published estimates of delirium occurrence in medical inpatients over four decades: a systematic review and meta-analysis study

Kate Gibb et al. Age Ageing. .

Abstract

Introduction: Delirium is associated with a wide range of adverse patient safety outcomes, yet it remains consistently under-diagnosed. We undertook a systematic review of studies describing delirium in adult medical patients in secondary care. We investigated if changes in healthcare complexity were associated with trends in reported delirium over the last four decades.

Methods: We used identical criteria to a previous systematic review, only including studies using internationally accepted diagnostic criteria for delirium (the Diagnostic and Statistical Manual of Mental Disorders and the International Statistical Classification of Diseases). Estimates were pooled across studies using random effects meta-analysis, and we estimated temporal changes using meta-regression. We investigated publication bias with funnel plots.

Results: We identified 15 further studies to add to 18 studies from the original review. Overall delirium occurrence was 23% (95% CI 19-26%) (33 studies) though this varied according to diagnostic criteria used (highest in DSM-IV, lowest in DSM-5). There was no change from 1980 to 2019, nor was case-mix (average age of sample, proportion with dementia) different. Overall, risk of bias was moderate or low, though there was evidence of increasing publication bias over time.

Discussion: The incidence and prevalence of delirium in hospitals appears to be stable, though publication bias may have masked true changes. Nonetheless, delirium remains a challenging and urgent priority for clinical diagnosis and care pathways.

Keywords: delirium; epidemiology; meta-analysis; older people; systematic review.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Meta-analysis of included studies (with studies from original review), stratified by diagnostic criteria and ordered by publication date. Note: Adamis (2015) and Thomas (2012) report prevalence by two diagnostic criteria in the sample but are weighted as separate studies.
Figure 2
Figure 2
(a–c) Temporal trends in delirium prevalence (top left), incidence (top right) and occurrence (bottom).
Figure 3
Figure 3
Funnel plot showing the occurrence of delirium in relation to standard error of the estimate, by decade.
See this image and copyright information in PMC

References

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