Practice Guidelines

Diagnosis, prevention, and management of delirium: summary of NICE guidance

BMJ 2010; 341 doi: http://dx.doi.org/10.1136/bmj.c3704 (Published 28 July 2010) Cite this as: BMJ 2010;341:c3704
  1. John Young, honorary consultant geriatrician1,
  2. Lakshmi Murthy, research fellow2,
  3. Maggie Westby, clinical effectiveness lead2,
  4. Anayo Akunne, health economist2,
  5. Rachel O’Mahony, senior research fellow2
  6. on behalf of the Guideline Development Group
  1. 1Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford
  2. 2National Clinical Guideline Centre, Royal College of Physicians, London
  1. Correspondence to: J Young john.young{at}bradfordhospitals.nhs.uk

    Delirium is a complex clinical syndrome characterised by disturbed consciousness, cognitive function, or perception. Sometimes known as acute confusional state, delirium has an acute onset, a fluctuating course, and is associated with serious adverse outcomes such as death, dementia, and the need for long term care.1 Although common in general hospitals (affecting as many as about 30% of inpatients)1 and care homes, delirium is often poorly recognised1; however, it can be prevented in about one third of patients at risk.1 This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) guideline on how to recognise, prevent, and treat delirium.2

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the experience of the Guideline Development Group and their opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Assessment of risk factors

    • When people first present to hospital or long term care, assess them for the presence of the following risk factors for delirium:

      • -Age 65 years or older

      • -Cognitive impairment (past or present), dementia, or both.3 If cognitive impairment is suspected, confirm it using a standardised and validated cognitive impairment measure, such as the mini mental state examination3

      • -Current hip fracture

      • -Severe illness (that is, a clinical condition that is deteriorating or at risk of deterioration).4

    [Based on moderate and low quality evidence from prospective cohort studies]

    • Observe people admitted to hospital or long term care at every opportunity for any changes in the risk factors for delirium. [Based on the experience and opinion of the Guideline Development Group (GDG)]

    Interventions to prevent delirium

    • Ensure that people at risk of delirium are cared …

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