{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T02:50:33Z","timestamp":1780109433116,"version":"3.54.0"},"reference-count":57,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,6,14]],"date-time":"2023-06-14T00:00:00Z","timestamp":1686700800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008794","name":"Research Manitoba","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008794","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009271","name":"Canadian Nurses Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009271","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Rationale<\/jats:title><jats:p>Older adults are at high risk of developing delirium in the emergency department (ED);\u00a0however, it is often missed or undertreated. Improving ED delirium care is challenging in part due to a lack of standards to guide best practice. Clinical practice guidelines (CPGs)\u00a0translate evidence into recommendations to improve practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To critically appraise and synthesize CPG recommendations for delirium care relevant to older ED patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted an umbrella review to retrieve relevant CPGs. Quality of the CPGs and their recommendations were critically appraised using the Appraisal of Guidelines, Research, and Evaluation (AGREE)\u2010II;\u00a0and Appraisal of Guidelines Research and Evaluation\u2014Recommendations Excellence (AGREE\u2010REX)\u00a0instruments. A threshold of 70% or greater in the AGREE\u2010II\u00a0Rigour of Development domain was used to define high\u2010quality CPGs. Delirium recommendations from CPGs meeting this threshold were included in the synthesis and narrative analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>AGREE\u2010II\u00a0Rigour of Development scores ranged from 37% to 83%, with 5 of 10 CPGs meeting the predefined threshold. AGREE\u2010REX\u00a0overall calculated scores ranged from 44% to 80%. Recommendations were grouped into screening, diagnosis, risk reduction, and management. Although none of the included CPGs were ED\u2010specific, many recommendations incorporated evidence from this setting. There was agreement that screening for nonmodifiable risk factors is important to define high\u2010risk populations, and those at risk should be screened for delirium. The \u20184A's Test\u2019 was the recommended tool to use in the ED specifically. Multicomponent strategies were recommended for delirium risk reduction, and for its management if it occurs. The only area of disagreement was for the short\u2010term use of antipsychotic medication in urgent situations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This is the first known review of delirium CPGs including a critical appraisal and synthesis of recommendations. Researchers and policymakers can use this synthesis to inform future improvement efforts and research in the ED.<\/jats:p><\/jats:sec><jats:sec><jats:title>Registration<\/jats:title><jats:p>This study has been registered in the Open Science Framework registries: <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/doi.org\/10.17605\/OSF.IO\/TG7S6\">https:\/\/doi.org\/10.17605\/OSF.IO\/TG7S6OSF.IO\/TG7S6<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jep.13883","type":"journal-article","created":{"date-parts":[[2023,6,15]],"date-time":"2023-06-15T02:23:30Z","timestamp":1686795810000},"page":"1039-1053","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A critical appraisal and recommendation synthesis of delirium clinical practice guidelines relevant to the care of older adults in the emergency department: An umbrella review"],"prefix":"10.1111","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8442-1990","authenticated-orcid":false,"given":"Sarah","family":"Filiatreault","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8015-8243","authenticated-orcid":false,"given":"Jeremy M.","family":"Grimshaw","sequence":"additional","affiliation":[{"name":"Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada"},{"name":"Department of Medicine University of Ottawa Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9499-2853","authenticated-orcid":false,"given":"Sara A.","family":"Kreindler","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alecs","family":"Chochinov","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"},{"name":"Department of Emergency Medicine, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3210-9022","authenticated-orcid":false,"given":"Janice","family":"Linton","sequence":"additional","affiliation":[{"name":"Neil John Maclean Health Sciences Library University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashmita","family":"Chatterjee","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Price Faculty of Engineering University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rilwan","family":"Azeez","sequence":"additional","affiliation":[{"name":"Department of Immunology University of Manitoba Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6889-9097","authenticated-orcid":false,"given":"Malcolm B.","family":"Doupe","sequence":"additional","affiliation":[{"name":"Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"},{"name":"Department of Emergency Medicine, Rady Faculty of Health Sciences University of Manitoba Winnipeg Manitoba Canada"},{"name":"Centre for Care Research Western University of Applied Sciences Bergen 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