{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T10:20:53Z","timestamp":1785320453876,"version":"3.55.0"},"reference-count":116,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Delirium is a common public health concern that significantly impacts older patients admitted to the Emergency Department (ED). This condition is linked to adverse outcomes such as reduced long-term functionality, higher mortality rates, extended hospital stays, and increased medical costs. The identification of risk factors is crucial for the early recognition and management of delirium in ED patients. Aging, cognitive decline, polypharmacy, and sensory impairment are some of the most common general risk factors described in the literature. Although validated delirium assessment tools already exist, they are not practical for the fast-paced ED environment because of their extended evaluation period or specialized training request. Moreover, clear guidance is needed to select the most suitable tool for detecting delirium, balancing between the accuracy and the swiftness required in an overcrowded, high-stress, and understaffed healthcare setting. This narrative review aims to analyze the updated literature on delirium risk factors in older ED patients and focuses on the methods for better screening, managing, and treating this condition in the ED.<\/jats:p>","DOI":"10.3390\/jcm12206587","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T10:36:56Z","timestamp":1697625416000},"page":"6587","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["A Lethal Combination of Delirium and Overcrowding in the Emergency Department"],"prefix":"10.3390","volume":"12","author":[{"given":"Alessandra","family":"Bonfichi","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5460-4625","authenticated-orcid":false,"given":"Iride Francesca","family":"Ceresa","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Humanitas University-Research Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5703-8737","authenticated-orcid":false,"given":"Andrea","family":"Piccioni","sequence":"additional","affiliation":[{"name":"Department of Emergency, Fondazione Policlinico Universitario A. Gemelli, IRCCS Fondazione Policlinico San Matteo, 00168 Roma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Zanza","sequence":"additional","affiliation":[{"name":"Italian Society of Pre-Hospital Emergency Medicine (SIS-118), 74121 Taranto, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8831-1361","authenticated-orcid":false,"given":"Yaroslava","family":"Longhitano","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Humanitas University-Research Hospital, 20089 Rozzano, Italy"},{"name":"Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15260, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7851-5130","authenticated-orcid":false,"given":"Zoubir","family":"Boudi","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Dr Sulaiman Alhabib Hospital, Dubai 2542, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ciro","family":"Esposito","sequence":"additional","affiliation":[{"name":"Nephrology and Dialysis Unit, ICS Maugeri, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8679-5435","authenticated-orcid":false,"given":"Gabriele","family":"Savioli","sequence":"additional","affiliation":[{"name":"Emergency Medicine and Surgery, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/j.emc.2010.03.005","article-title":"Delirium in the Older Emergency Department Patient\u2014A Quiet Epidemic","volume":"28","author":"Han","year":"2010","journal-title":"Emerg. Med. Clin. N. Am."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1111\/j.1532-5415.1994.tb06551.x","article-title":"Delirium in Hospitalized Older Persons: Outcomes and Predictors","volume":"42","author":"Pompei","year":"1994","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1016\/j.ajem.2023.01.040","article-title":"Association of delirium with increased short-term mortality among older emergency department patients: A cohort study","volume":"66","author":"Arneson","year":"2023","journal-title":"Am. J. Emerg. Med."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Abraha, I., Trotta, F., Rimland, J.M., Cruz-Jentoft, A., Lonzano-Montoya, I., Soiz, R.L., Pierini, V., Dess\u00ec Fulgheri, P., Lattanzio, F., and O\u2019Mahony, D. (2015). Efficacy of non-pharmacological interventions to prevent and treat delirium in older patients: A systematic overview. The SENATOR project ONTOP series. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0123090"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1038\/s41572-020-00223-4","article-title":"Delirium","volume":"6","author":"Wilson","year":"2022","journal-title":"Nat. Rev. Dis. Prim."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1176\/appi.psy.50.3.234","article-title":"Impact of delirium on short-term mortality in elderly inpatients: A prospective cohort study","volume":"50","author":"Villarroel","year":"2009","journal-title":"Psychosomatics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1097\/TME.0000000000000066","article-title":"Assessment and management of delirium in older adults in the emergency department: Literature review to inform development of a novel clinical protocol","volume":"37","author":"Rosen","year":"2015","journal-title":"Adv. Emerg. Nurs. J."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1186\/cc5787","article-title":"Clinical review: Agitation and delirium in the critically ill\u2014Significance and management","volume":"11","author":"Chevrolet","year":"2007","journal-title":"Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/s40138-021-00226-9","article-title":"Succinct Approach to Delirium in the Emergency Department","volume":"9","author":"Lee","year":"2021","journal-title":"Curr. Emerg. Hosp. Med. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Saviano, A., Zanza, C., Longhitano, Y., Ojetti, V., Franceschi, F., Bellou, A., Voza, A., Ceresa, I.F., and Savioli, G. (2023). Current Trends for Delirium Screening within the Emergency Department. Medicina, 59.","DOI":"10.3390\/medicina59091634"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/0735-6757(95)90080-2","article-title":"Unrecognized delirium in ED geriatric patients","volume":"13","author":"Lewis","year":"1995","journal-title":"Am. J. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2642","DOI":"10.1111\/jocn.16349","article-title":"Identification through the Manchester Triage System of the older population at risk of delirium: A case\u2013control study","volume":"32","year":"2023","journal-title":"J. Clin. Nurs."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Savioli, G., Ceresa, I.F., Bressan, M.A., Bavestrello Piccini, G., Varesi, A., Novelli, V., Muzzi, A., Cutti, S., Ricevuti, G., and Esposito, C. (2023). Five Level Triage vs. Four Level Triage in a Quaternary Emergency Department: National Analysis on Waiting Time, Validity, and Crowding\u2014The CREONTE (Crowding and RE-Organization National TriagE) Study Group. Medicina, 59.","DOI":"10.3390\/medicina59040781"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/jgs.12692","article-title":"Delirium Risk Prediction, Health Care Utilization and Mortality of Elderly Emergency Department Patients","volume":"62","author":"Kennedy","year":"2014","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_15","first-page":"1","article-title":"Risk factors for delirium among older adults in the emergency department: A systematic review protocol","volume":"10","author":"Silva","year":"2020","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.annemergmed.2013.11.010","article-title":"Screening for delirium in the emergency department: A systematic review","volume":"63","author":"Lamantia","year":"2014","journal-title":"Ann. Emerg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1002\/gps.4823","article-title":"Delirium pathophysiology: An updated hypothesis of the etiology of acute brain failure","volume":"33","author":"Maldonado","year":"2018","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1038\/s41582-022-00698-7","article-title":"The inter-relationship between delirium and dementia: The importance of delirium prevention","volume":"18","author":"Fong","year":"2022","journal-title":"Nat. Rev. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1111\/j.1553-2712.2008.00339.x","article-title":"Delirium in Older Emergency Department Patients: Recognition, Risk Factors, and Psychomotor Subtypes","volume":"16","author":"Han","year":"2009","journal-title":"Acad. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1017\/S1041610291000613","article-title":"Delirium: Phenomenologic and Etiologic Subtypes","volume":"3","author":"Ross","year":"1991","journal-title":"Int. Psychogeriatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"684594","DOI":"10.3389\/fmed.2021.684594","article-title":"The Reliability of Anamnestic Data in the Management of Clostridium Tetani Infection in Elderly","volume":"8","author":"Savioli","year":"2021","journal-title":"Front. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1007\/s40520-015-0487-0","article-title":"Reliability of an anamnestic questionnaire for the diagnosis of benign paroxysmal positional vertigo in the elderly","volume":"28","author":"Lapenna","year":"2015","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_23","first-page":"41","article-title":"The reliability of psychiatric diagnosis revisited: The clinician\u2019s guide to improve the reliability of psychiatric diagnosis","volume":"3","author":"Aboraya","year":"2006","journal-title":"Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"490947","DOI":"10.1155\/2015\/490947","article-title":"Medical History of Elderly Patients in the Emergency Setting: Not an Easy Point-of-Care Diagnostic Marker","volume":"2015","author":"Lindner","year":"2015","journal-title":"Emerg. Med. Int."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1093\/brain\/aws190","article-title":"Delirium is a strong risk factor for dementia in the oldest-old: A population-based cohort study","volume":"135","author":"Davis","year":"2012","journal-title":"Brain"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1093\/ageing\/afx149","article-title":"Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees","volume":"47","author":"Brady","year":"2018","journal-title":"Age Ageing"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1723","DOI":"10.1046\/j.1532-5415.2002.50468.x","article-title":"Delirium superimposed on dementia: A systematic review","volume":"50","author":"Fick","year":"2002","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1177\/0891988707303338","article-title":"Symptom profile of delirium in older people with and without dementia","volume":"20","author":"Edlund","year":"2007","journal-title":"J. Geriatr. Psychiatry Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"30","DOI":"10.3928\/0098-9134-20000101-09","article-title":"Consequences of not recognizing delirium superimposed on dementia in hospitalized elderly individuals","volume":"26","author":"Fick","year":"2000","journal-title":"J. Gerontol. Nurs."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1111\/jgs.16437","article-title":"Delirium in the Emergency Department: Moving from tool-based research to system-wide change","volume":"68","author":"Kennedy","year":"2020","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1111\/j.1553-2712.2011.01040.x","article-title":"Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: Brief Alzheimer\u2019s screen, short blessed test, Ottawa 3DY, and the caregiver-completed AD8","volume":"18","author":"Carpenter","year":"2011","journal-title":"Acad. Emerg. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Bellelli, G., Morandi, A., Di Santo, S.G., Mazzone, A., Cherubini, A., Bossello, E., Bo, M., Bianchetti, A., Rozzini, R., and Zanetti, E. (2016). \u2018Delirium Day\u2019: A nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Med., 14.","DOI":"10.1186\/s12916-016-0649-8"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"2029","DOI":"10.1097\/CCM.0000000000003402","article-title":"Incidence and Prevalence of Delirium Subtypes in an Adult ICU: A Systematic Review and Meta-Analysis","volume":"46","author":"Krewulak","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/bmjopen-2012-001772","article-title":"Delirium in an adult acute hospital population: Predictors, prevalence and detection","volume":"3","author":"Ryan","year":"2013","journal-title":"BMJ Open"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.bpa.2012.07.003","article-title":"Epidemiology and risk factors for delirium accross hospital settings","volume":"26","author":"Vasilevskis","year":"2012","journal-title":"Best Prac. Res. Clin. Anaesthesiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1016\/j.jemermed.2019.05.024","article-title":"Unrecognized Incident Delirium in Older Emergency Department Patients","volume":"57","author":"Boucher","year":"2019","journal-title":"J. Emerg. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ajem.2022.05.058","article-title":"Delirium prevalence in geriatric emergency department patients: A systematic review and meta-analysis","volume":"59","author":"Chen","year":"2022","journal-title":"Am. J. Emerg. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1046\/j.1532-5415.2003.51151.x","article-title":"Delirium in older emergency department patients discharged home: Effect on survival","volume":"51","author":"Kakuma","year":"2003","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1136\/postgradmedj-2012-131608","article-title":"Emergency physician recognition of delirium","volume":"89","author":"Suffoletto","year":"2013","journal-title":"Postgrad. Med. J."},{"key":"ref_40","first-page":"349","article-title":"Recognition, prevention, and treatment of delirium in emergency department: An evidence-based narrative review","volume":"38","author":"Sangil","year":"2019","journal-title":"Am. J. Emerg. Med."},{"key":"ref_41","first-page":"CD013307","article-title":"Non-pharmacological interventions for preventing delirium in hospitalised non-ICU patients (Review)","volume":"7","author":"Burton","year":"2021","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1093\/gerona\/59.4.M350","article-title":"Delirium Symptoms and Low Dietary Intake in Older Inpatients Are Independent Predictors of Institutionalization: A 1-Year Prospective Population-Based Study","volume":"59","author":"Vincent","year":"2004","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_43","first-page":"S241","article-title":"The Importance of Delirium: Economic and Societal Costs","volume":"59","author":"Manuscript","year":"2011","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1001\/jama.1996.03530350034031","article-title":"Precipitating Factors for Delirium in Hospitalized Elderly Persons","volume":"275","author":"Inouye","year":"1996","journal-title":"JAMA"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1016\/j.jpsychores.2008.05.019","article-title":"Unravelling the pathophysiology of delirium: A focus on the role of aberrant stress responses","volume":"65","author":"MacLullich","year":"2008","journal-title":"J. Psychosom. Res."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1038\/s41593-018-0234-x","article-title":"The role of brain vasculature in neurodegenerative disorders","volume":"21","author":"Sweeney","year":"2018","journal-title":"Nat. Neurosci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"9275","DOI":"10.1523\/JNEUROSCI.2614-05.2005","article-title":"Central and systemic endotoxin challenges exacerbate the local inflammatory response and increase neuronal death during chronic neurodegeneration","volume":"25","author":"Cunningham","year":"2005","journal-title":"J. Neurosci."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.jpsychores.2006.11.013","article-title":"Cytokines and acute phase response in delirium","volume":"62","author":"Korevaar","year":"2007","journal-title":"J. Psychosom. Res."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Atterton, B., Paulino, M.C., Povoa, P., and Martin-Loeches, I. (2020). Sepsis associated delirium. Medicina, 56.","DOI":"10.3390\/medicina56050240"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ajem.2016.10.004","article-title":"Etiologies and delirium rates of elderly ED patients with acutely altered mental status: A multicenter prospective study","volume":"35","author":"Aslaner","year":"2017","journal-title":"Am. J. Emerg. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.pmn.2009.07.002","article-title":"Nursing Care, Delirium, and Pain Management for the Hospitalized Older Adult","volume":"11","author":"Schreier","year":"2010","journal-title":"Pain Manag. Nurs."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.jcrc.2017.06.009","article-title":"Low brain tissue oxygenation contributes to the development of delirium in critically ill patients: A prospective observational stud","volume":"41","author":"Wood","year":"2017","journal-title":"J. Crit. Care"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1136\/pgmj.2003.017236","article-title":"An approach to drug induced delirium in the elderly","volume":"80","author":"Alagiakrishnan","year":"2004","journal-title":"Postgrad. Med. J."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"910125","DOI":"10.5402\/2013\/910125","article-title":"Risk Factors for Acute Delirium in Critically Ill Adult Patients: A Systematic Review","volume":"2013","author":"Mattar","year":"2013","journal-title":"ISRN Crit. Care"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s40520-015-0359-7","article-title":"Anticholinergic drugs and negative outcomes in the older population: From biological plausibility to clinical evidence","volume":"28","author":"Collamati","year":"2016","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.jamda.2020.04.019","article-title":"Anticholinergic Drug Burden and Delirium: A Systematic Review","volume":"22","author":"Egberts","year":"2021","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1016\/j.ccc.2008.06.004","article-title":"Pathoetiological Model of Delirium: A Comprehensive Understanding of the Neurobiology of Delirium and an Evidence-Based Approach to Prevention and Treatment","volume":"24","author":"Maldonado","year":"2008","journal-title":"Crit. Care Clin."},{"key":"ref_58","first-page":"232","article-title":"Risk Factors for Delirium: Are Systematic Reviews Enough?","volume":"43","author":"Wipt","year":"2015","journal-title":"NIH"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1016\/j.jpsychores.2008.05.026","article-title":"Predisposing and precipitating factors for delirium in a frail geriatric population","volume":"65","author":"Laurila","year":"2008","journal-title":"J. Psychosom. Res."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1176\/jnp.2010.22.3.329","article-title":"Relationship BetweenCognitive Status atAdmission and Incident Delirium in OlderMedical Inpatients","volume":"22","author":"Franco","year":"2010","journal-title":"J. Neuropsychiatry Clin. Neurosci."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1046\/j.1525-1497.1998.00047.x","article-title":"Delirium risk factors in elderly hospitalized patients","volume":"13","author":"Elie","year":"1998","journal-title":"J. Gen. Intern. Med."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jagp.2014.08.005","article-title":"Worsening cognitive impairment and neurodegenerative pathology progressively increase risk for delirium","volume":"23","author":"Davis","year":"2015","journal-title":"Am. J. Geriatr. Psychiatry"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"R77","DOI":"10.1186\/cc7892","article-title":"Risk factors for delirium in intensive care patients: A prospective cohort study","volume":"13","author":"Elseviers","year":"2009","journal-title":"Crit. Care"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2174\/1574887117666220826164723","article-title":"Invasive Mechanical Ventilation in Traumatic Brain Injured Patients with Acute Respiratory Failure","volume":"18","author":"Racca","year":"2023","journal-title":"Rev. Recent Clin. Trials."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1097\/CCM.0000000000000625","article-title":"A Systematic Review of Risk Factors for Delirium in the ICU","volume":"43","author":"Zaal","year":"2015","journal-title":"Soc. Crit. Care Med."},{"key":"ref_66","first-page":"53","article-title":"Sedation in the intensive care setting","volume":"4","author":"Hughes","year":"2012","journal-title":"Clin. Pharmacol. Adv. Appl."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"h2538","DOI":"10.1136\/bmj.h2538","article-title":"Outcome of delirium in critically ill patients: Systematic review and meta-analysis","volume":"350","author":"Salluh","year":"2015","journal-title":"BMJ"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.jcrc.2020.01.017","article-title":"Risk factors and outcomes among delirium subtypes in adult ICUs: A systematic review","volume":"56","author":"Krewulak","year":"2020","journal-title":"J. Crit. Care"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1016\/j.jvs.2017.04.077","article-title":"A systematic review and meta-analysis of factors for delirium in vascular surgical patients","volume":"66","author":"Oldroyd","year":"2017","journal-title":"J. Vasc. Surg."},{"key":"ref_70","first-page":"195","article-title":"Postoperative Delirium","volume":"2021","author":"Tarasova","year":"2021","journal-title":"Neuroanesthesia"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1093\/ageing\/afu022","article-title":"Risk factors for incident delirium among older people in acute hospital medical units: A systematic review and meta-analysis","volume":"43","author":"Ahmed","year":"2014","journal-title":"Age Ageing"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1093\/gerona\/glr040","article-title":"High yield research opportunities in geriatric emergency medicine: Prehospital care, delirium, adverse drug events, and falls","volume":"66","author":"Carpenter","year":"2011","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1007\/s43678-020-00004-8","article-title":"Predictors of delirium in older patients at the emergency department: A prospective multicentre derivation study","volume":"23","author":"Nadeau","year":"2021","journal-title":"Can. J. Emerg. Med."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1007\/s11739-021-02732-w","article-title":"How the coronavirus disease 2019 pandemic changed the patterns of healthcare utilization by geriatric patients and the crowding: A call to action for effective solutions to the access block","volume":"17","author":"Savioli","year":"2022","journal-title":"Intern. Emerg. Med."},{"key":"ref_75","doi-asserted-by":"crossref","unstructured":"Savioli, G., Ceresa, I.F., Gri, N., Bavestrello Piccini, G., Yaroslava, L., Zanza, C., Piccioni, A., Esposito, C., Ricevuti, G., and Bressan, M.A. (2022). Emergency Department Overcrowding: Understanding the Factors to Find Corresponding Solutions. J. Pers. Med., 12.","DOI":"10.3390\/jpm12020279"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1067\/mem.2003.302","article-title":"A conceptual model of emergency department crowding","volume":"42","author":"Asplin","year":"2003","journal-title":"Ann. Emerg. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"860","DOI":"10.5811\/westjem.2021.2.49611","article-title":"Impact of Coronavirus Disease 2019 Pandemic on Crowding: A Call to Action for Effective Solutions to \u2018access Block\u2019","volume":"22","author":"Savioli","year":"2021","journal-title":"West. J. Emerg. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"d2983","DOI":"10.1136\/bmj.d2983","article-title":"Association between waiting times and short term mortality and hospital admission after departure from emergency department: Population based cohort study from Ontario, Canada","volume":"342","author":"Guttmann","year":"2011","journal-title":"BMJ"},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"Lauque, D., Khalemsky, A., Zoubir, B., \u00d6stlundh, L., Xu, C., Alsabri, M., Onveji, C., Cellini, J., Intas, G., and Kapil, D.S. (2023). Length-of-Stay in the Emergency Department and In-Hospital Mortality: A Systematic Review and Meta-Analysis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12010032"},{"key":"ref_80","first-page":"726","article-title":"Increased emergency department hallway length of stay is associated with development of delirium","volume":"22","author":"Singla","year":"2021","journal-title":"West. J. Emerg. Med."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1114","DOI":"10.1111\/jgs.14103","article-title":"Length of Stay in the Emergency Department and Occurrence of Delirium in Older Medical Patients","volume":"64","author":"Bo","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_82","first-page":"10","article-title":"Emergency Department Stay Associated Delirium in Older Patients","volume":"20","author":"Grenier","year":"2017","journal-title":"Can. Geriatr. J."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/S0140-6736(13)60688-1","article-title":"Delirium in elderly people","volume":"383","author":"Inouye","year":"2014","journal-title":"Lancet"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1016\/j.annemergmed.2019.07.023","article-title":"Managing Delirium and Agitation in the Older Emergency Department Patient: The ADEPT Tool","volume":"75","author":"Shenvi","year":"2019","journal-title":"Ann. Emerg. Med."},{"key":"ref_85","unstructured":"NICE (2023). Delirium: Prevention, Diagnosis and Management in Hospital and Long-Term Care, NICE."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"1838","DOI":"10.1111\/jgs.17740","article-title":"Can we improve delirium prevention and treatment in the emergency department? A systematic review","volume":"70","author":"Lee","year":"2022","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1002\/gps.2582","article-title":"Melatonin decreases delirium in elderly patients: A randomized, placebo-controlled trial","volume":"26","author":"Brymer","year":"2011","journal-title":"Int. J. Geriatr. Psychiatry"},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"280","DOI":"10.4103\/JETS.JETS_137_17","article-title":"Emergency Department Interventions and Their Effect on Delirium\u2019s Natural Course: The Folly May be in the Foley","volume":"12","author":"Noel","year":"2019","journal-title":"J. Emerg. Trauma Shock"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1111\/j.1553-2712.2009.00382.x","article-title":"Quality indicators for geriatric emergency care","volume":"16","author":"Teller","year":"2009","journal-title":"Acad. Emerg. Med."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1093\/ageing\/afaa069","article-title":"Use of a digital delirium pathway and quality improvement to improve delirium detection in the emergency department and outcomes in an acute hospital","volume":"49","author":"Vardy","year":"2020","journal-title":"Age Ageing"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1136\/emermed-2011-200586","article-title":"Delirium within the emergency care setting, occurrence and detection: A systematic review","volume":"30","author":"Barron","year":"2013","journal-title":"Emerg. Med. J."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"e24779","DOI":"10.1097\/MD.0000000000024779","article-title":"Delirium screening tools in the emergency department","volume":"100","author":"Zhang","year":"2021","journal-title":"Medicine"},{"key":"ref_93","unstructured":"SIG Network (2019). SIGN Evidence Based Clinical Guidelines, SIG Network."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"941","DOI":"10.7326\/0003-4819-113-12-941","article-title":"Clarifying confusion: The confusion assessment method. A new method for detection of delirium","volume":"113","author":"Inouye","year":"1990","journal-title":"Ann. Intern. Med."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"103782","DOI":"10.1016\/j.ijnurstu.2020.103782","article-title":"Diagnostic accuracy of the CAM-ICU and ICDSC in detecting intensive care unit delirium: A bivariate meta-analysis","volume":"113","author":"Chen","year":"2021","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.annemergmed.2013.05.003","article-title":"Diagnosing delirium in older emergency department patients: Validity and reliability of the delirium triage screen and the brief confusion assessment method","volume":"62","author":"Han","year":"2013","journal-title":"Ann. Emerg. Med."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1111\/jgs.16438","article-title":"Family Identification of Delirium in the Emergency Department in Patients with and Without Dementia: Validity of the Family Confusion Assessment Method (FAM-CAM)","volume":"68","author":"Mailhot","year":"2020","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"903","DOI":"10.1017\/cem.2018.367","article-title":"Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department","volume":"20","author":"Voyer","year":"2018","journal-title":"CJEM"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1097\/00131746-200511001-00002","article-title":"The expert consensus guideline series. Treatment of behavioral emergencies 2005","volume":"11","author":"Allen","year":"2005","journal-title":"J. Psychiatr. Pract."},{"key":"ref_100","first-page":"123","article-title":"Safety and efficacy of pharmacologic agents used for rapid tranquilization of emergency department patients with acute agitation or excited delirium","volume":"20","author":"Hong","year":"2020","journal-title":"Expert Opin. Drug Saf."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1067\/mem.2003.110","article-title":"Droperidol, QT prolongation, and sudden death: What is the evidence?","volume":"41","author":"Kao","year":"2003","journal-title":"Ann. Emerg. Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1016\/j.jemermed.2014.12.024","article-title":"American academy of emergency medicine position statement: Safety of droperidol use in the emergency department","volume":"49","author":"Perkins","year":"2015","journal-title":"J. Emerg. Med."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1056\/NEJMoa1808217","article-title":"Haloperidol and Ziprasidone for Treatment of Delirium in Critical Illness","volume":"379","author":"Girard","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"2506","DOI":"10.1056\/NEJMoa1808217","article-title":"Delirium and acute confusional states: Prevention, treatment and prognosis","volume":"379","author":"Girard","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/jhm.2019","article-title":"Quetiapine for the treatment of delirium","volume":"8","author":"Hawkins","year":"2013","journal-title":"J. Hosp. Med."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"705","DOI":"10.1111\/jgs.14076","article-title":"Antipsychotic Medication for Prevention and Treatment of Delirium in Hospitalized Adults: A Systematic Review and Meta-Analysis","volume":"64","author":"Neufeld","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.eplepsyres.2009.03.007","article-title":"Benzodiazepine modulation of GABAA receptor opening frequency depends on activation context: A patch clamp and simulation study","volume":"85","author":"Bianchi","year":"2009","journal-title":"Epilepsy Res."},{"key":"ref_108","first-page":"1167","article-title":"Management of acute undifferentiated agitation in the emergency department: A randomized double-blind trial of droperidol, ziprasidone, and midazolam","volume":"12","author":"Martel","year":"2005","journal-title":"Acad. Emerg. Med."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/j.annemergmed.2005.07.003","article-title":"Randomized clinical trial comparing intravenous midazolam and droperidol for sedation of the acutely agitated patient in the emergency department","volume":"47","author":"Knott","year":"2006","journal-title":"Ann. Emerg. Med."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/j.1553-2712.2004.tb00738.x","article-title":"A prospective, double-blind, randomized trial of midazolam versus haloperidol versus lorazepam in the chemical restraint of violent and severely agitated patients","volume":"11","author":"Nobay","year":"2004","journal-title":"Acad. Emerg. Med."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1016\/j.annemergmed.2018.04.027","article-title":"Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department","volume":"72","author":"Klein","year":"2018","journal-title":"Ann. Emerg. Med."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1111\/jgs.13702","article-title":"American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults","volume":"63","author":"Samuel","year":"2015","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1002\/phar.2060","article-title":"Ketamine for the Acute Management of Excited Delirium and Agitation in the Prehospital Setting","volume":"38","author":"Linder","year":"2018","journal-title":"Pharmacotherapy"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1016\/j.jcrc.2016.05.016","article-title":"Ketamine for analgosedation in critically ill patients","volume":"35","author":"Erstad","year":"2016","journal-title":"J. Crit. Care"},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1016\/j.ajem.2017.02.026","article-title":"Ketamine as a first-line treatment for severely agitated emergency department patients","volume":"35","author":"Riddell","year":"2017","journal-title":"Am. J. Emerg. Med."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1093\/gerona\/63.1.56","article-title":"Multicomponent geriatric intervention for elderly inpatients with delirium: Effects on costs and health-related quality of life","volume":"63","author":"Pitkala","year":"2008","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6587\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:08:53Z","timestamp":1760130533000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/20\/6587"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,18]]},"references-count":116,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcm12206587"],"URL":"https:\/\/doi.org\/10.3390\/jcm12206587","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,18]]}}}