Postgraduate medical journal · 2025
Perceived prevalence, risk factors, and reported management of delirium in critically ill emergency patients: a survey of physicians in China.
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Shang Wen, Zheng Kang, Du Lanfang, Zhang Hua, Yang Rongjia, Chen Fengying, Liu Wencao, Yan Xianliang, Ma Qingbian
Аннотация
PURPOSE: To investigate Chinese emergency physicians' perceptions of prevalence, associated risk factors, and reported management practices for delirium in critically ill emergency department (ED) patients.
METHODS: A cross-sectional survey of 402 physicians from EDs across 18 Chinese provinces.
RESULTS: Physician-estimated delirium prevalence varied widely (median: 15%; interquartile range: 10%-30%), with most perceiving higher incidence during night shifts. Key perceived risk factors included metabolic disorders, pre-existing cognitive impairment, shock, and severe infections. Clinical judgment was the most common assessment method; structured screening tools were reportedly used infrequently. Pharmacological interventions were the preferred management approach for most respondents.
CONCLUSIONS: This survey highlights Chinese emergency physicians' varied perceptions of delirium prevalence and reliance on clinical judgment over standardized assessment. Findings suggest a need for enhanced training in standardized screening, greater emphasis on non-pharmacological interventions, and fostering interprofessional collaboration to improve care for ED patients with or at risk of delirium. Key messages What is already known on this topic: Delirium is a serious acute neurocognitive syndrome with high Intensive Care Unit prevalence (31.8%-70%) and significant adverse outcomes. Emergency department delirium remains under recognized despite 6%-38% prevalence in older adults. International guidelines recommend non-pharmacological interventions as first-line management. What this study adds: This survey provides the first assessment of Chinese emergency physicians' delirium perceptions in critically ill patients. Key findings reveal predominant reliance on clinical judgment rather than validated tools and a preference for pharmacological interventions, particularly benzodiazepines, which conflicts with international guidelines. Substantial variation exists in perceived prevalence estimates. How this study might affect research, practice, or policy: Findings inform targeted educational initiatives for Chinese emergency departments, emphasizing the need for standardized screening training and non-pharmacological intervention promotion. Future research should prioritize objective epidemiological studies to validate perceived prevalence rates and evaluate protocol implementation.
METHODS: A cross-sectional survey of 402 physicians from EDs across 18 Chinese provinces.
RESULTS: Physician-estimated delirium prevalence varied widely (median: 15%; interquartile range: 10%-30%), with most perceiving higher incidence during night shifts. Key perceived risk factors included metabolic disorders, pre-existing cognitive impairment, shock, and severe infections. Clinical judgment was the most common assessment method; structured screening tools were reportedly used infrequently. Pharmacological interventions were the preferred management approach for most respondents.
CONCLUSIONS: This survey highlights Chinese emergency physicians' varied perceptions of delirium prevalence and reliance on clinical judgment over standardized assessment. Findings suggest a need for enhanced training in standardized screening, greater emphasis on non-pharmacological interventions, and fostering interprofessional collaboration to improve care for ED patients with or at risk of delirium. Key messages What is already known on this topic: Delirium is a serious acute neurocognitive syndrome with high Intensive Care Unit prevalence (31.8%-70%) and significant adverse outcomes. Emergency department delirium remains under recognized despite 6%-38% prevalence in older adults. International guidelines recommend non-pharmacological interventions as first-line management. What this study adds: This survey provides the first assessment of Chinese emergency physicians' delirium perceptions in critically ill patients. Key findings reveal predominant reliance on clinical judgment rather than validated tools and a preference for pharmacological interventions, particularly benzodiazepines, which conflicts with international guidelines. Substantial variation exists in perceived prevalence estimates. How this study might affect research, practice, or policy: Findings inform targeted educational initiatives for Chinese emergency departments, emphasizing the need for standardized screening training and non-pharmacological intervention promotion. Future research should prioritize objective epidemiological studies to validate perceived prevalence rates and evaluate protocol implementation.