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

Authors

  • Karin J. Neufeld MD, MPH,

    Corresponding author
    1. Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, Maryland
    • Address correspondence to Karin J. Neufeld, Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, A4 Center Suite 457, 4940 Eastern Avenue, Baltimore, MD 21224. E-mail: kneufel2@jhmi.edu

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    • Karin J. Neufeld and Jirong Yue contributed equally to this article as co-first authors.
  • Jirong Yue MD,

    1. Department of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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    • Karin J. Neufeld and Jirong Yue contributed equally to this article as co-first authors.
  • Thomas N. Robinson MD, MPH,

    1. Department of Surgery, School of Medicine, University of Colorado, Aurora, Colorado
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  • Sharon K. Inouye MD, MPH,

    1. Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
    2. Institute for Aging Research, Hebrew Senior Life, Boston, Massachusetts
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    • Sharon K. Inouye and Dale M. Needham contributed equally to this article as co-senior authors.
  • Dale M. Needham MD, PhD

    1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
    2. Department of Physical Medicine and Rehabilitation, School of Medicine, Johns Hopkins University, Baltimore, Maryland
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    • Sharon K. Inouye and Dale M. Needham contributed equally to this article as co-senior authors.

Errata

This article is corrected by:

  1. Errata: Erratum Volume 64, Issue 10, 2171–2173, Article first published online: 20 October 2016

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 I2 > 50%. Using a random-effects model (I2 > 50%) or a fixed-effects model (I2 < 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, I2 = 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, I2 = 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.

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