Skip to main content
SpringerLink
Log in

Delirium screening tools in the post-anaesthetic care unit: a systematic review and meta-analysis

  • Review
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

Delirium is a serious neurocognitive disorder among surgical patients in the post-anaesthetic care unit (PACU). Despite the development of screening tools to identify delirium, it is not clear which tool is the most accurate and reliable in assessing delirium in the PACU.

Aim

To examine the diagnostic accuracy of delirium screening tools used in the PACU.

Methods

A systematic literature search of CINAHL, MEDLINE, Embase, PsycINFO and Scopus was conducted, using MeSH terms and relevant keywords, from databases establishment to 23 April 2021. Studies were assessed for methodological quality using the Standards for Reporting of Diagnostic Accuracy Studies (STARD) tool.

Results

A total of 1503 studies were screened from the database search, four studies met the inclusion criteria for this review. Six delirium screening tools used in the PACU were identified in the selected studies. Three studies evaluated screening tools in adult surgical patients without cognitive impairment and dementia. Two studies evaluated screening tools among patients who were scheduled for elective surgery. Review results indicated that two tools, the 4A’s test (4AT; sensitivity 96%; specificity 99%) and the 3 min diagnostic interview for the Confusion Assessment Method (3D-CAM; sensitivity 100%; specificity 88%), had greatest validity and reliability as a screening tool for detecting delirium in the PACU.

Conclusion

Results indicate the 4AT and the 3D-CAM are most accurate screening tools to detect delirium in the PACU. Further research is required to validate those tools among a broader surgical population, including patients with cognitive impairment, dementia and those undergoing emergency surgical procedures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Inouye SK, Westendorp RGJ, Saczynski JS (2014) Delirium in elderly people. Lancet 9920:911

    Article  Google Scholar 

  2. Aldwikat RK, Manias E, Nicholson P (2020) Incidence and risk factors for acute delirium in older patients with a hip fracture: a retrospective cohort study. Nurs Health Sci. https://doi.org/10.1111/nhs.12753

    Article  PubMed  Google Scholar 

  3. Lee HB et al (2011) Predisposing factors for postoperative delirium after hip fracture repair in individuals with and without dementia. J Am Geriatr Soc 59:2306–2313

    Article  Google Scholar 

  4. Lee KH et al (2011) Frequency, risk factors, and prognosis of prolonged delirium in elderly patients after hip fracture surgery. Clin Orthop Relat Res 469:2612–2620

    Article  Google Scholar 

  5. Saller T et al (2019) Screening for delirium after surgery: validation of the 4 A’s test (4AT) in the post-anaesthesia care unit. Anaesthesia 74:1260–1266

    Article  CAS  Google Scholar 

  6. Neufeld KJ et al (2013) Evaluation of two delirium screening tools for detecting post-operative delirium in the elderly. Br J Anaesth 111:612–618

    Article  CAS  Google Scholar 

  7. Veiga D et al (2012) Postoperative delirium in intensive care patients: risk factors and outcome. Braz J Anesthesiol 62:469–483

    Article  Google Scholar 

  8. Marcantonio ER (2020) Still predicting delirium after all these years. Anesth Analg 130:76–78

    Article  Google Scholar 

  9. Aldecoa C et al (2017) European society of anaesthesiology evidence-based and consensus-based guideline on postoperative delirium. Eur J Anaesthesiol 34:192–214

    Article  Google Scholar 

  10. Sendelbach S, Guthrie PF (2009) Acute confusion/delirium: evidence-based practice guideline. University of Iowa Gerontological Nursing Interventions Research Center

    Google Scholar 

  11. National Institute for Health and Care Excellence (2014) Delirium: prevention, diagnosis and management. https://www.nice.org.UK/Guidance/cg103. Accessed 2 Aug 2020

  12. Qian Z et al (2021) Delirium screening tools in the emergency department: a protocol for systematic review and meta-analysis. Medicine 100:1–5

    Google Scholar 

  13. Bond P, Goudie K (2015) Identifying and managing patients with delirium in acute care settings. Nurs Older People 27:28–32

    Article  Google Scholar 

  14. American Psychiatric Association (1980) The diagnostic and statistical manual of mental disorders: DSM-III in 1980, 3rd edn. American Psychiatric Publishing

    Google Scholar 

  15. Saller T et al (2021) Implementation of strategies to prevent and treat postoperative delirium in the post-anesthesia caring unit: a German survey of current practice. J Clin Monit Comput 35:599–605

    Article  Google Scholar 

  16. Grover S, Kate N (2012) Assessment scales for delirium: a review. World J Psychiatry 2:58–70

    Article  Google Scholar 

  17. Olbert M et al (2018) 3D-CAM guideline-conform translation for german-speaking countries. Anasthesiol Intensivmed Notfallmed Schmerzther 53:793–796

    Article  Google Scholar 

  18. Stukenberg S et al (2016) How can postoperative delirium be predicted in advance? A secondary analysis comparing three methods of early assessment in elderly patients. Minerva Anestesiol 82:751–759

    PubMed  Google Scholar 

  19. McInnes MDF et al (2018) Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement. JAMA 319:388–396

    Article  Google Scholar 

  20. Akobeng AK (2007) Understanding diagnostic tests 1: sensitivity, specificity and predictive values. Acta Paediatr 96:338–341

    Article  Google Scholar 

  21. De J, Wand AP (2015) Delirium screening: a systematic review of delirium screening tools in hospitalized patients. Gerontologist 55:1079–1099

    Article  Google Scholar 

  22. Bossuyt PM et al (2003) The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. Clin Chem 1:7

    Article  Google Scholar 

  23. Olbert M et al (2019) Validation of 3-minute diagnostic interview for CAM-defined delirium to detect postoperative delirium in the recovery room: a prospective diagnostic study. Eur J Anaesthesiol 36:683–687

    Article  Google Scholar 

  24. Radtke FM et al (2008) Comparison of three scores to screen for delirium in the recovery room. Br J Anaesth 101:338–343

    Article  CAS  Google Scholar 

  25. Tim M, Dawid P (2019) An algorithm for the classification of study designs to assess diagnostic, prognostic and predictive test accuracy in systematic reviews. Syst Rev 8:1–8

    Article  Google Scholar 

  26. Kamarudin AN, Cox T, Kolamunnage-Dona R (2017) Time-dependent ROC curve analysis in medical research: current methods and applications. BMC Med Res Methodol 17:53

    Article  Google Scholar 

  27. Abelha FJ et al (2010) Evaluation of delirium in postoperative patients: translation and validation of the intensive care delirium screening checklist in a Portuguese post anesthesia care unit. Arq Med 24:121–128

    Google Scholar 

  28. Hight DF et al (2018) Inattentive delirium vs. Disorganized thinking: a new axis to subcategorize PACU delirium. Front Syst Neurosci. https://doi.org/10.3389/fnsys.2018.00022

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pipanmekaporn T et al (2014) Validity and reliability of the Thai version of the confusion assessment method for the intensive care unit (CAM-ICU). Clin Interv Aging 9:879–885

    Article  Google Scholar 

  30. Conti G et al (2014) Sedation and weaning from mechanical ventilation: time for ‘best practice’ to catch up with new realities? Multidiscip Respir Med 9:45

    Article  Google Scholar 

  31. Moreira FT, Neto AS (2016) Sedation in mechanically ventilated patients—time to stay awake? Ann Transl Med. https://doi.org/10.21037/atm.2016.09.37

    Article  PubMed  PubMed Central  Google Scholar 

  32. Australian College of Peri Anaesthesia Nurses, Statement on Staffing. 2018: ACPAN, Retreived 05 Sep 2020, <https://acpan.edu.au/statements=>

  33. Yates C et al (2009) Screening instruments for delirium in older people with an acute medical illness. Age Ageing 38:235–237

    Article  Google Scholar 

  34. Leung JLM et al (2008) Clinical utility and validation of two instruments (the confusion assessment method algorithm and the Chinese version of nursing delirium screening scale) to detect delirium in geriatric inpatients. Gen Hosp Psychiatry 30:171–176

    Article  Google Scholar 

  35. Bellelli G et al (2014) Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing 43:496–502

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Lisa Grbin librarian at Deakin University for her assistance with the development of the search strategy and systematic search. We also thank Susan Monaghan at the Royal Melbourne Hospital for her assistance with EndNote referencing system.

Funding

For this study, there is no funding source.

Author information

Authors and Affiliations

  1. School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia

    Rami K. Aldwikat, Elizabeth Manias, Emily Tomlinson, Mohammed Amin & Patricia Nicholson

  2. Faculty of Health, Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia

    Rami K. Aldwikat, Elizabeth Manias, Emily Tomlinson, Mohammed Amin & Patricia Nicholson

  3. Operating Theatre, The Royal Melbourne Hospital, Parkville, VIC, Australia

    Rami K. Aldwikat

  4. Institute for Health Transformation, Deakin University, Geelong, VIC, Australia

    Elizabeth Manias, Emily Tomlinson & Patricia Nicholson

  5. Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia

    Elizabeth Manias

Authors
  1. Rami K. Aldwikat
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elizabeth Manias
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emily Tomlinson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mohammed Amin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Patricia Nicholson
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

RA, EM, ET and PN have contributed to the design of the systematic review. RA, MA, ET and PN were responsible for performing data collection. RA, EM, ET and PN have conducted analysis and interpretation of the data. RA was responsible for drafting the first version of the paper. EM, ET and PN critically revised the manuscript. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work and read and approved final manuscript.

Corresponding author

Correspondence to Rami K. Aldwikat.

Ethics declarations

Conflict of interest

All authors of this study declare no competing interests.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by the authors.

Informed consent

For this type of study, formal consent is not required.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 22 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aldwikat, R.K., Manias, E., Tomlinson, E. et al. Delirium screening tools in the post-anaesthetic care unit: a systematic review and meta-analysis. Aging Clin Exp Res 34, 1225–1235 (2022). https://doi.org/10.1007/s40520-021-02057-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-021-02057-w

Keywords

Search

Navigation