Quality assessment of the guidelines for the management of delirium in adult patients_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Guiying , WANG Yangyang , XU Kepei , LI Yang ,  LIU Huaping

School of Nursing, Peking Union Medical College, Beijing 100144, P.R.China;

Corresponding?author：

LIU Huaping, Email: huapingliu@pumc.edu.cn

Keywords：

Delirium; Clinical practice guideline; Systematic review; AGREE II

DOI：

10.7507/1672-2531.201910139

Video：

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Objective To evaluate the quality of guidelines for the management of delirium in adult patients in the last ten years, so as to provide references for updating, selection, implementation guidelines and delirium management optimization.Methods We searched guidelines from databases including PubMed, EMbase, WanFang Data and CNKI, and websites of guidelines from January 1^st 2010 to September 1^st 2019. Guidelines were comprehensively screened, evaluated based on AGREE Ⅱ and data was independently extracted by two researchers.Results Guidelines of NICE, RNAO and SIGN had higher scores, while CSCCM’s and IPS’s gained lower. Among domains of AGREE Ⅱ, Domain I (scope and purpose) and IV (clarity of presentation) scored the highest, with a minimum of Domain Ⅱ (stakeholder involvement) and V (applicability). Delirium management focused on screening, prediction, prevention and treatment both pharmacologically and non-pharmacologically, and information support.Conclusions Future development of delirium guidelines should follow the methodology of guideline development, update or adjustment, and dedicate to every domain, especially domain of application. Medical staffs can establish our own domestic guidelines based on high quality guidelines, to promote knowledge translation and delirium management.

Citation： LIU Guiying, WANG Yangyang, XU Kepei, LI Yang, LIU Huaping. Quality assessment of the guidelines for the management of delirium in adult patients. Chinese Journal of Evidence-Based Medicine, 2020, 20(7): 837-844. doi: 10.7507/1672-2531.201910139 Copy

1.	Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1): 263-306.
2.	Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med, 2014, 370(5): 444-454.
3.	Grover S, Avasthi A. Clinical practice guidelines for management of delirium in elderly. Indian J Psychiatry, 2018, 60(Suppl 3): S329-S340.
4.	Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
5.	Davis D, Searle SD, Tsui A. The Scottish Intercollegiate Guidelines Network: risk reduction and management of delirium. Age Ageing, 2019, 48(4): 485-488.
6.	Registered Nurses’ Association of Ontario. Delirium, dementia, and depression in older adults: assessment and care. Available from: https://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression.
7.	Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet, 2014, 383(9920): 911-922.
8.	Neufeld KJ, Thomas C. Delirium: definition, epidemiology, and diagnosis. J Clin Neurophysiol, 2013, 30(5): 438-442.
9.	Delaney A, Hammond N, Litton E. Preventing delirium in the intensive care unit. JAMA, 2018, 319(7): 659-660.
10.	Institute of Medicine (US). Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Graham R, Mancher M. Clinical practice guidelines we can trust. Washington, DC: National Academies Press, 2011.
11.	袁帥, 李亞斐. 臨床實踐指南的制定方法和評價原則. 中華乳腺病雜志 (電子版), 2014, 8(04): 283-287.
12.	陳尹, 胡世蓮, 李幼平, 等. 全球藥物干預治療單純性高血壓指南的系統評價. 中國循證醫學雜志, 2012, 12(10): 1180-1194.
13.	Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 2018, 46(9): e825-e873.
14.	Bush SH, Lawlor PG, Ryan K, et al. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol, 2018, 29(Suppl 4): i143-i165.
15.	中華醫學會重癥醫學分會. 中國成人 ICU 鎮痛和鎮靜治療指南. 中華重癥醫學電子雜志 (網絡版), 2018, 4(2): 90-113.
16.	DAS-Taskforce 2015, Baron R, Binder A, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015)-short version. Ger Med Sci, 2015, 13: Doc19.
17.	American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc, 2015, 63(1): 142-150.
18.	Gage L, Hogan DB. CCSMH Guideline update: The assessment and treatment of delirium. Toronto: Canadian Coalition for Seniors’ Mental Health (CCSMH), 2014.
19.	Celis-Rodríguez E, Birchenall C, de la Cal Má, et al. Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients. Med Intensiva, 2013, 37(8): 519-574.
20.	National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and treatment. Available from: https://www.nice.org.uk/guidance/cg103.
21.	Brajtman S, Wright D, Hogan DB, et al. Developing guidelines on the assessment and treatment of delirium in the older adults at the end of life. Can Geriatr J, 2011, 14(2): 40-50.
22.	Khodambashi S, Nytr? ?. Reviewing clinical guideline development tools: features and characteristics. BMC Med Inform Decis Mak, 2017, 17(1): 132.
23.	Bush SH, Marchington KL, Agar M, et al. Quality of clinical practice guidelines in delirium: a systematic appraisal. BMJ Open, 2017, 7(3): e013809.
24.	Alonso-Coello P, Oxman AD, Moberg J, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ, 2016, 353: i2089.
25.	Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin, 2013, 29(1): 51-65.

1. Barr J, Fraser GL, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med, 2013, 41(1): 263-306.
2. Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med, 2014, 370(5): 444-454.
3. Grover S, Avasthi A. Clinical practice guidelines for management of delirium in elderly. Indian J Psychiatry, 2018, 60(Suppl 3): S329-S340.
4. Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol, 2017, 34(4): 192-214.
5. Davis D, Searle SD, Tsui A. The Scottish Intercollegiate Guidelines Network: risk reduction and management of delirium. Age Ageing, 2019, 48(4): 485-488.
6. Registered Nurses’ Association of Ontario. Delirium, dementia, and depression in older adults: assessment and care. Available from: https://rnao.ca/bpg/guidelines/assessment-and-care-older-adults-delirium-dementia-and-depression.
7. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet, 2014, 383(9920): 911-922.
8. Neufeld KJ, Thomas C. Delirium: definition, epidemiology, and diagnosis. J Clin Neurophysiol, 2013, 30(5): 438-442.
9. Delaney A, Hammond N, Litton E. Preventing delirium in the intensive care unit. JAMA, 2018, 319(7): 659-660.
10. Institute of Medicine (US). Committee on Standards for Developing Trustworthy Clinical Practice Guidelines, Graham R, Mancher M. Clinical practice guidelines we can trust. Washington, DC: National Academies Press, 2011.
11. 袁帥, 李亞斐. 臨床實踐指南的制定方法和評價原則. 中華乳腺病雜志 (電子版), 2014, 8(04): 283-287.
12. 陳尹, 胡世蓮, 李幼平, 等. 全球藥物干預治療單純性高血壓指南的系統評價. 中國循證醫學雜志, 2012, 12(10): 1180-1194.
13. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med, 2018, 46(9): e825-e873.
14. Bush SH, Lawlor PG, Ryan K, et al. Delirium in adult cancer patients: ESMO Clinical Practice Guidelines. Ann Oncol, 2018, 29(Suppl 4): i143-i165.
15. 中華醫學會重癥醫學分會. 中國成人 ICU 鎮痛和鎮靜治療指南. 中華重癥醫學電子雜志 (網絡版), 2018, 4(2): 90-113.
16. DAS-Taskforce 2015, Baron R, Binder A, et al. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015)-short version. Ger Med Sci, 2015, 13: Doc19.
17. American Geriatrics Society Expert Panel on Postoperative Delirium in Older Adults. American Geriatrics Society abstracted clinical practice guideline for postoperative delirium in older adults. J Am Geriatr Soc, 2015, 63(1): 142-150.
18. Gage L, Hogan DB. CCSMH Guideline update: The assessment and treatment of delirium. Toronto: Canadian Coalition for Seniors’ Mental Health (CCSMH), 2014.
19. Celis-Rodríguez E, Birchenall C, de la Cal Má, et al. Clinical practice guidelines for evidence-based management of sedoanalgesia in critically ill adult patients. Med Intensiva, 2013, 37(8): 519-574.
20. National Institute for Health and Care Excellence. Delirium: prevention, diagnosis and treatment. Available from: https://www.nice.org.uk/guidance/cg103.
21. Brajtman S, Wright D, Hogan DB, et al. Developing guidelines on the assessment and treatment of delirium in the older adults at the end of life. Can Geriatr J, 2011, 14(2): 40-50.
22. Khodambashi S, Nytr? ?. Reviewing clinical guideline development tools: features and characteristics. BMC Med Inform Decis Mak, 2017, 17(1): 132.
23. Bush SH, Marchington KL, Agar M, et al. Quality of clinical practice guidelines in delirium: a systematic appraisal. BMJ Open, 2017, 7(3): e013809.
24. Alonso-Coello P, Oxman AD, Moberg J, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 2: Clinical practice guidelines. BMJ, 2016, 353: i2089.
25. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin, 2013, 29(1): 51-65.

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