Abstract
The Scottish Intercollegiate Guidelines Network (SIGN) guideline on delirium is a major advance on existing guidelines on this condition. This is particularly important given the evidence it is frequently under-diagnosed and inadequately managed despite being common and frequently associated with significant patient and carer distress and poor outcomes. The guidelines recommend using the 4A’s test to help detect delirium. A bundle of mostly non-pharmacological therapies minimise the risk of developing delirium and can help those who develop the condition. The importance of medical optimisation by an experienced professional in those at risk of delirium is highlighted with new recommendations for people in intensive care and surgical settings. There is guidance on follow-up of people with delirium, which should become routine. This commentary piece focusses on areas with the greatest potential to improve the experience and outcomes of those with delirium, and briefly discusses areas of ongoing uncertainty.
Highlights
Delirium is a state of acute deterioration in mental functioning that occurs soon after acute medical illness, surgery, trauma, or a change in medications [1]
In patients who have experienced delirium in intensive care units (ICU), consideration should be given to follow-up for psychological sequelae including cognitive impairment
There was insufficient evidence to make any firm recommendations in other settings, such as primary care, but the guideline suggests the 4AT could be used to identify those with probable delirium
Summary
Delirium is a state of acute deterioration in mental functioning that occurs soon after acute medical illness, surgery, trauma, or a change in medications [1] It causes significant patient and caregiver distress [2] and is associated with multiple serious complications, i.e., falling and/or worsened outcomes that increase the length of stay in hospitals and have higher rates of death and institutionalization [1]. The development of a robust new guideline by the Scottish Intercollegiate Guidance Network (SIGN) is a very welcome development [6] It showcases the state-of-the-art practices in delirium prevention and management, providing a list of 12 evidence-based recommendations (see Section 1.1) and expert opinion-based ‘good practice points’ (see Section 1.2), which are applicable to a wide range of healthcare settings. In patients who have experienced delirium in intensive care units (ICU), consideration should be given to follow-up for psychological sequelae including cognitive impairment
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call