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J Am Geriatr Soc. 2016 Apr;64(4):705-14. doi: 10.1111/jgs.14076. Epub 2016 Mar 23.

Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis.

Author information

1
Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
2
Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
3
Department of Surgery, School of Medicine, University of Colorado, Aurora, Colorado.
4
Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
5
Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts.
6
Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland.
7
Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland.

Erratum in

Abstract

OBJECTIVES:

To evaluate the effectiveness of antipsychotic medications in preventing and treating delirium.

DESIGN:

Systematic review and meta-analysis.

SETTING:

PubMed, EMBASE, CINAHL, and ClinicalTrials.gov databases were searched from January 1, 1988, to November 26, 2013.

PARTICIPANTS:

Adult surgical and medical inpatients.

INTERVENTION:

Antipsychotic administration for delirium prevention or treatment in randomized controlled trials or cohort studies.

MEASUREMENTS:

Two authors independently reviewed all citations, extracted relevant data, and assessed studies for potential bias. Heterogeneity was considered as chi-square P < .1 or I(2) > 50%. Using a random-effects model (I(2) > 50%) or a fixed-effects model (I(2) < 50%), odds ratios (ORs) were calculated for dichotomous outcomes (delirium incidence and mortality), and mean or standardized mean difference for continuous outcomes (delirium duration, severity, hospital and intensive care unit (ICU) length of stay (LOS)). Sensitivity analyses included postoperative prevention studies only, exclusion of studies with high risk of bias, and typical versus atypical antipsychotics.

RESULTS:

Screening of 10,877 eligible records identified 19 studies. In seven studies comparing antipsychotics with placebo or no treatment for delirium prevention after surgery, there was no significant effect on delirium incidence (OR = 0.56, 95% confidence interval (CI) = 0.23-1.34, I(2) = 93%). Using data reported from all 19 studies, antipsychotic use was not associated with change in delirium duration, severity, or hospital or ICU LOS, with high heterogeneity among studies. No association with mortality was detected (OR = 0.90, 95% CI = 0.62-1.29, I(2) = 0%).

CONCLUSION:

Current evidence does not support the use of antipsychotics for prevention or treatment of delirium. Additional methodologically rigorous studies using standardized outcome measures are needed.

KEYWORDS:

adult; delirium; pharmacological prevention; pharmacological treatment

PMID:
27004732
PMCID:
PMC4840067
DOI:
10.1111/jgs.14076
[Indexed for MEDLINE]
Free PMC Article

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