Delirium in Critically Ill Geriatric Surgical Patients: A Systematic Review of Screening, Risk Factors, Diagnosis, and Management.

OBJECTIVE

This systematic review aims to evaluate optimal early screening strategies, significant risk factors, and effective diagnostic and management approaches for delirium in critically ill geriatric surgical patients.

DATA SOURCES: A comprehensive search was conducted across five databases: PubMed, Google Scholar, ProQuest, Embase, and Cochrane.

STUDY SELECTION: Studies were included based on their relevance to early screening, risk factors, diagnostic accuracy, and management strategies for delirium in critically ill geriatric surgical patients. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

DATA EXTRACTION: A total of 31 studies met the inclusion criteria. Outcomes of interest included effective early screening/prevention strategies, significant risk factors, sensitive diagnosis tools, and effective management strategies.

DATA SYNTHESIS: Early screening strategies, including advanced neural networks and E-PROD-NS, demonstrated high sensitivity and specificity (area under the receiver operating characteristic curve >0.76). Key risk factors included advanced age, renal dysfunction, cognitive impairment, prolonged intensive care unit length of stay (ICU-LOS), and mechanical ventilation time. Diagnostic tools such as the 4A's test and serum biomarkers exhibited superior accuracy compared to the ICU Confusion Assessment Method and Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) criteria. Management strategies effectively reduced delirium duration, including acetaminophen, environmental modifications, and family involvement.

CONCLUSIONS

E-PROD-NS and the 4A's test were associated with early delirium detection and intervention. Risk factors for delirium included advanced age, renal dysfunction, and existing cognitive dysfunction. Mitigating mechanical ventilation and ICU-LOS duration, treatment with acetaminophen, and environmental modifications reduced delirium duration in critically ill geriatric surgical patients.

REGISTRATION: PROSPERO #CRD42025632279.