Structured Abstract

Contents

• Key Messages
• Preface
• Acknowledgments
• Key Informants
• Technical Expert Panel
• Peer Reviewers
• Evidence Summary
  • Introduction
  • Methods
  • Results
  • Discussion
  • Conclusions
  • References
• Introduction
  • Background
  • Scope and Key Questions
• Methods
  • Topic Refinement and Protocol Development
  • Literature Search Strategy
  • Process for Study Selection
  • Data Extraction and Data Management
  • Risk of Bias Assessment
  • Data Synthesis
  • Grading the Body of Evidence for Each Key Question
  • Peer Review and Public Commentary
• Results
  • Search Results
  • Key Question 1. Benefits and Harms of Antipsychotics To Prevent Delirium
  • Key Question 1a. Benefits and Harms of Antipsychotics To Prevent Delirium in Persons Aged 65 Years and Older
  • Key Question 1b. Benefits and Harms of Antipsychotics To Prevent Delirium in Persons with Dementia
  • Key Question 1c. Benefits and Harms of Antipsychotics To Prevent Delirium in Patients in an Intensive Care Unit
  • Key Question 1d. Benefits and Harms of Antipsychotics To Prevent Delirium in Patients in a Post-Acute Care Facility
  • Key Question 1e. Benefits and Harms of Antipsychotics To Prevent Delirium in Patients in Palliative or Hospice Care
  • Key Question 1f. Benefits and Harms of Antipsychotics To Prevent Delirium in Patients in Postoperative Care
  • Key Question 2. Benefits and Harms of Antipsychotics To Treat Delirium
  • Key Question 2a. Benefits and Harms of Antipsychotics To Treat Delirium in Persons Aged 65 Years and Older
  • Key Question 2b. Benefits and Harms of Antipsychotics To Treat Delirium in Persons With Dementia
  • Key Question 2c. Benefits and Harms of Antipsychotics To Treat Delirium in Patients in an Intensive Care Unit
  • Key Question 2d. Benefits and Harms of Antipsychotics To Treat Delirium in Patients in a Post-Acute Care Facility
  • Key Question 2e. Benefits and Harms of Antipsychotics To Treat Delirium in Patients in Palliative or Hospice Care
  • Key Question 2f. Benefits and Harms of Antipsychotics To Treat Delirium in Patients in Postoperative Care
• Discussion
  • Key Findings and Strength of Evidence
  • Findings in Relationship to What Is Already Known
  • Applicability
  • Implications for Clinical and Policy Decisionmaking
  • Limitations of the Systematic Review Process
  • Limitations of the Evidence Base
  • Research Recommendations
  • Conclusions
• References
• Abbreviations and Acronyms
• Appendixes
  • Appendix A. Detailed Search Strategy
  • Appendix B. Screening and Data Abstraction Forms
  • Appendix C. Included and Excluded Articles
  • Appendix D. Evidence Tables

Suggested citation:

Neufeld KJ, Needham DM, Oh ES, Wilson LM, Nikooie R, Zhang A, Koneru M, Balagani A, Singu S, Aldabain L, Robinson KA. Antipsychotics for the Prevention and Treatment of Delirium. Comparative Effectiveness Review No. 219. (Prepared by the Johns Hopkins University Evidence-based Practice Center under Contract No. 290-2015-00006-I-2.) AHRQ Publication No. 19-EHC019-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2019. Posted final reports are located on the Effective Health Care Program search page. DOI: https://doi.org/10.23970/AHRQEPCCER219.

This report is based on research conducted by the Johns Hopkins University Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00006-I-2). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.

Two investigators were members of the guideline panel for a 2018 Society for Clinical Care Medicine guideline for the management of pain, sedation, delirium, rehabilitation, and sleep for critically ill patients. Two investigators co-authored the American Geriatric Society guidelines for post-operative delirium in older adults. None of the other investigators have any affiliations or financial involvement that conflicts with the material presented in this report.

The information in this report is intended to help healthcare decision makers—patients and clinicians, health system leaders, and policymakers, among others—make well-informed decisions and thereby improve the quality of healthcare services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.

This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.

AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.

This report may periodically be assessed for the currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program website at www.effectivehealthcare.ahrq.gov. Search on the title of the report.

People using assistive technology may not be able to fully access information in this report. For assistance contact vog.shh.qrha@CPE.