Emerg Med J 30:263-268 doi:10.1136/emermed-2011-200586
  • Review

Delirium within the emergency care setting, occurrence and detection: a systematic review

  1. John Holmes
  1. Academic Unit of Psychiatry, St. James University Hospital, University of Leeds, Leeds, Yorkshire, UK
  1. Correspondence to Dr Ewan Alexander Barron, Academic Unit of Psychiatry, Basement floor Beckett Wing, St. James University Hospital, Leeds, Yorkshire LS9 7TF, UK; ewan.barron{at}
  1. Contributors EB is the main author and guarantor, contributing to concept design, full review, draft ownership, analysis, production of paper and reviews. JH is the coauthor, contributing to secondary review, draft revision, reviewer and final approval.

  • Accepted 23 May 2012
  • Published Online First 25 July 2012


Recent recommendations from the Society for Academic Emergency Medicine and the American College of Emergency Physicians identified the detection of delirium in the emergency department (ED) as a ‘high yield’ research objective. This review aimed to determine the occurrence rate, and physician detection rates, of delirium within the ED. A systematic literature review was conducted and identified using online databases. Prospective cohort and cross-sectional studies from hospital EDs were interrogated. Systematic data extraction and assessments of quality were carried out. Searching yielded 723 publications, and 13 papers met inclusion criteria. Occurrence of delirium at admission to the ED ranged from 7% to 20% of patients. Physician diagnosis rates of preconfirmed delirium (using a specified tool) within the ED varied between 11.1% and 46.0%. Many studies used non-validated assessment tools to gather data. Four delirium outcome studies were conducted in the ED setting. Results vary, with several being of poor quality; however, delirium at ED presentation may have a significant effect on long-term outcomes. Delirium is a significant concern in the ED, with many delirious patients not identified by physicians. Given the scale, addressing delirium should be a priority for clinicians and researchers. To improve delirium outcomes and hospital management, measures must include mechanisms to improve detection. Finding a single validated assessment method and facilitating research in this difficult patient population would be an important progress.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

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