New evidence on delirium from NICE


Around 20% of people on medical wards in hospital are affected by delirium. Sometimes called ‘acute confusional state’, delirium is a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course.

NICE issued guidance on delirium in July 2010 and they have now published an evidence update which brings together new research published on the diagnosis, prevention and management of the condition. The short (20 page) report highlights 17 new systematic reviews, randomised controlled trials and observational studies published since August 2009.

The aim of these evidence updates is to highlight new research that may have a potential impact on existing NICE guidance. NICE guidelines tend to get updated once every 5 years or thereabouts, so these updates aim to fill in the gaps.

One potential change has been identified by this new search, which is about the assessment of risk factors of patients in intensive care:

Use of the 10-item tool, PRE-DELIRIC (prediction of delirium in ICU patients), to assess the risk of patients in intensive care for developing delirium may be a consideration for future guidance reviews. A risk-assessment tool is not currently recommended.

The report also covers studies relating to a number of interventions including:

  • Multidisciplinary care
  • Bright light therapy
  • Pain management
  • Melatonin
  • Haloperidol, olanzapine and risperidone
  • Rivastigmine
  • Benzodiazepines


Delirium: evidence update. A summary of selected new evidence relevant to NICE clinical guideline 103 ‘Delirium: diagnosis, prevention and management’ (PDF). NHS Evidence, April 2012.

Delirium: diagnosis, prevention and management, CG103 (PDF). NICE, Jul 2010.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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