scholarly journals Choice architecture interventions to improve diet and/or dietary behaviour by healthcare staff in high-income countries: a systematic review

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e023687 ◽  
Author(s):  
Lena Al-Khudairy ◽  
Olalekan A Uthman ◽  
Rosemary Walmsley ◽  
Samantha Johnson ◽  
Oyinlola Oyebode
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Included Study ◽  
High Income ◽  
Dietary Behaviour ◽  
Choice Architecture ◽  
Cochrane Central Register ◽  
Healthcare Staff ◽  
Quality Appraisal ◽  
Healthcare Settings

ObjectivesWe were commissioned by the behavioural insights team at Public Health England to synthesise the evidence on choice architecture interventions to increase healthy purchasing and/or consumption of food and drink by National Health Service (NHS) staff.Data sourcesMEDLINE, EMBASE, CINAHL, Cochrane Central register of Controlled Trials, PsycINFO, Applied Social Sciences Index and Abstracts and Web of Science were searched from inception until May 2017 and references were screened independently by two reviewers.DesignA systematic review that included randomised experimental or intervention studies, interrupted time series and controlled before and after studies.ParticipantsHealthcare staff of high-income countries.InterventionChoice architecture interventions that aimed to improve dietary purchasing and/or consumption (outcomes) of staff.Appraisal and synthesisEligibility assessment, quality appraisal, data abstraction and analysis were completed by two reviewers. Quality appraisal of randomised trials was informed by theCochrane Handbook, and the Risk of Bias Assessment Tool for Nonrandomized Studies was used for the remainder. Findings were narratively synthesised.ResultsEighteen studies met the inclusion criteria. Five studies included multiple workplaces (including healthcare settings), 13 were conducted in healthcare settings only. Interventions in 10 studies were choice architecture only and 8 studies involved a complex intervention with a choice architecture element. Interventions involving a proximity element (making behavioural options easier or harder to engage with) appear to be frequently effective at changing behaviour. One study presented an effective sizing intervention. Labelling alone was generally not effective at changing purchasing behaviour. Interventions including an availability element were generally reported to be successful at changing behaviour but no included study examined this element alone. There was no strong evidence for the effect of pricing on purchasing or dietary intake.ConclusionProximity, availability and sizing are choice architecture elements that are likely to be effective for NHS organisations.Trial registration numberCRD42017064872.

scholarly journals A systematic review of endoscopic versus open treatment of craniosynostosis. Part 2: the nonsagittal single sutures

2018 ◽  
Vol 22 (4) ◽  
pp. 361-368 ◽  
Author(s):  
Han Yan ◽  
Taylor J. Abel ◽  
Naif M. Alotaibi ◽  
Melanie Anderson ◽  
Toba N. Niazi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Loss ◽  
Assessment Tool ◽  
Operating Time ◽  
Length Of Hospital Stay ◽  
Transfusion Rate ◽  
Cochrane Central Register ◽  
Qualitative Synthesis ◽  
Endoscopic Techniques ◽  
Single Suture

OBJECTIVEDespite increasing adoption of endoscopic techniques for repair of nonsagittal single-suture craniosynostosis, the efficacy and safety of the procedure relative to established open approaches are unknown. In this systematic review the authors aimed to directly compare open surgical and endoscope-assisted techniques for the treatment of metopic, unilateral coronal, and lambdoid craniosynostosis, with an emphasis on quantitative reported outcomes.METHODSA literature search was performed in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were identified from 3 electronic databases (MEDLINE, EMBASE, and CENTRAL [Cochrane Central Register of Controlled Trials]) from their inception to August 2017. The quality of methodology and bias risk were assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies.RESULTSOf 316 screened records, 7 studies were included in a qualitative synthesis of the evidence, of which none were eligible for meta-analysis. These reported on 111 unique patients with metopic, 65 with unilateral coronal, and 12 with lambdoid craniosynostosis. For all suture types, 100 (53%) children underwent endoscope-assisted craniosynostosis surgery and 32 (47%) patients underwent open repair. These studies all suggest that blood loss, transfusion rate, operating time, and length of hospital stay were superior for endoscopically treated children. Although potentially comparable or better cosmetic outcomes are reported, the paucity of evidence and considerable variability in outcomes preclude meaningful conclusions.CONCLUSIONSLimited data comparing open and endoscopic treatments for metopic, unilateral coronal, and lambdoid synostosis suggest a benefit for endoscopic techniques with respect to blood loss, transfusion, length of stay, and operating time. This report highlights shortcomings in evidence and gaps in knowledge regarding endoscopic repair of nonsagittal single-suture craniosynostosis, emphasizing the need for further matched-control studies.

scholarly journals Effects of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain: a protocol of a systematic review

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Naiane Teixeira Bastos de Oliveira ◽  
Irlei dos Santos ◽  
Gisela Cristiane Miyamoto ◽  
Cristina Maria Nunes Cabral
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Aerobic Exercise ◽  
Musculoskeletal Pain ◽  
Included Study ◽  
Chronic Musculoskeletal Pain ◽  
Current Evidence ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
And Function

Abstract Background Chronic musculoskeletal pain affects the quality of life of older adults by interfering in their ability to perform activities of daily living. Aerobic exercise programs have been used in the treatment of various health conditions, including musculoskeletal disorders. However, there is still little evidence on the effects of aerobic exercise for the treatment of older adults with chronic musculoskeletal pain. Thus, the objective of this study is to assess the effects of aerobic exercise in improving pain and function of older adults with chronic pain as a consequence of different chronic musculoskeletal conditions. Methods The databases to be used in the search are PubMed, EMBASE, CINAHL, PEDro, and Cochrane Central Register of Controlled Trials (CENTRAL). Randomized controlled trials that used aerobic exercise in the treatment of older adults with chronic musculoskeletal pain will be included. Primary outcomes will be pain and function. We will use the PEDro scale to evaluate the methodological quality and statistical description of each included study, and the strength of the recommendations will be summarized using GRADE. Discussion The results of this systematic review will provide a synthesis of the current evidence on the effects of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain. In addition, this information can help health professionals in decision-making about the use of aerobic exercise in the treatment of older adults with chronic musculoskeletal pain. Ethics and dissemination This systematic review was recorded prospectively, and the results will be part of a doctoral thesis to be published in a peer-reviewed international journal and possibly presented at international conferences. Systematic review registration PROSPERO, CRD42019118903.

Clinical, Endoscopic and Histological Outcomes in Induction of Moderate-to-Severe Ulcerative Colitis: A Systematic Review with Meta-Analysis

2020 ◽  
Author(s):  
Fernando Magro ◽  
Maria Manuela Estevinho ◽  
Cláudia Camila Dias ◽  
Luís Correia ◽  
Paula Lago ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ulcerative Colitis ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Pharmacological Intervention ◽  
Controlled Trials ◽  
Significant Heterogeneity ◽  
Cochrane Central Register ◽  
Histological Remission ◽  
The Impact

Abstract Background and Aims Interest in histology for ulcerative colitis [UC] has increased recently. This systematic review and meta-analysis aims to assess, for the first time, whether histological outcomes are more informative than endoscopic and clinical outcomes in distinguishing the impact of intervention over placebo in induction trials. Methods MEDLINE, ScienceDirect and Cochrane Central Register of Controlled Trials were searched to identify randomized placebo-controlled trials [RCTs] enrolling moderate-to-severe UC patients. Studies were assessed using the Quality Assessment Tool for Studies with Diverse Designs. We analysed the pooled proportion of patients achieving clinical, endoscopic and histological remission and response after a pharmacological intervention and compared the results with those of placebo-treated patients by using a random-effects model. Results From 889 identified records, 13 RCTs were included. The odds ratio [OR] for remission was higher in patients receiving intervention than in those under placebo for clinical (OR 2.13, 95% confidence interval [CI] 1.33–3.43), endoscopic [OR 1.46, 95% CI 0.19–11.18] and histological remission [OR 1.85, 95% CI 1.20–2.84]. Significant differences were observed for all response outcomes [clinical: OR 2.27, 95% CI 1.84–2.85; endoscopic: OR 2.16, 95% CI 1.51–3.10; histological: OR 3.63, 95% CI, 1.41–9.36]. No significant heterogeneity existed; no subgroup effects were found for duration of the induction or histological scale [p > 0.05]. Clinical and histological remission and endoscopic response were concordant in discriminating interventions from placebo. Conclusion Histological outcomes are informative in trials of moderate-to-severe UC. Further studies analysing histology at the end of induction are needed to confirm its relevance in distinguishing the efficacy of an intervention over placebo in comparison to clinical and endoscopic outcomes and to explore its prognostic value.

scholarly journals Impact of integrating pharmacists into primary care teams on health systems indicators: a systematic review

2019 ◽  
Vol 69 (687) ◽  
pp. e665-e674 ◽  
Author(s):  
Benedict Hayhoe ◽  
Jose Acuyo Cespedes ◽  
Kimberley Foley ◽  
Azeem Majeed ◽  
Judith Ruzangi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health System ◽  
Quality Assessment ◽  
Observational Studies ◽  
Assessment Tool ◽  
Risk Of Bias ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Quality Assessment Tool

BackgroundEvidence suggests that pharmacists integrated into primary care can improve patient outcomes and satisfaction, but their impact on healthcare systems is unclear.AimTo identify the key impacts of pharmacists’ integration into primary care on health system indicators, such as healthcare utilisation and costs.Design and settingA systematic review of literature.MethodEmbase, MEDLINE, Scopus, the Health Management Information Consortium, CINAHL, and the Cochrane Central Register of Controlled Trials databases were examined, along with reference lists of relevant studies. Randomised controlled trials (RCTs) and observational studies published up until June 2018, which considered health system outcomes of the integration of pharmacists into primary care, were included. The Cochrane risk of bias quality assessment tool was used to assess risk of bias for RCTs; the National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool was used for observational studies. Data were extracted from published reports and findings synthesised.ResultsSearches identified 3058 studies, of which 28 met the inclusion criteria. Most included studies were of fair quality. Pharmacists in primary care resulted in reduced use of GP appointments and reduced emergency department (ED) attendance, but increased overall primary care use. There was no impact on hospitalisations, but some evidence of savings in overall health system and medication costs.ConclusionIntegrating pharmacists into primary care may reduce GP workload and ED attendance. However, further higher quality studies are needed, including research to clarify the cost-effectiveness of the intervention and the long-term impact on health system outcomes.

scholarly journals Systematic review of clinician-directed nudges in healthcare contexts

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e048801
Author(s):  
Briana S Last ◽  
Alison M Buttenheim ◽  
Carter E Timon ◽  
Nandita Mitra ◽  
Rinad S Beidas
Keyword(s):  
Systematic Review ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Assessment Tool ◽  
Risk Of Bias ◽  
Minimal Risk ◽  
Clinical Decisions ◽  
Snowball Sampling ◽  
Healthcare Settings ◽  
Default Options

ObjectiveNudges are interventions that alter the way options are presented, enabling individuals to more easily select the best option. Health systems and researchers have tested nudges to shape clinician decision-making with the aim of improving healthcare service delivery. We aimed to systematically study the use and effectiveness of nudges designed to improve clinicians’ decisions in healthcare settings.DesignA systematic review was conducted to collect and consolidate results from studies testing nudges and to determine whether nudges directed at improving clinical decisions in healthcare settings across clinician types were effective. We systematically searched seven databases (EBSCO MegaFILE, EconLit, Embase, PsycINFO, PubMed, Scopus and Web of Science) and used a snowball sampling technique to identify peer-reviewed published studies available between 1 January 1984 and 22 April 2020. Eligible studies were critically appraised and narratively synthesised. We categorised nudges according to a taxonomy derived from the Nuffield Council on Bioethics. Included studies were appraised using the Cochrane Risk of Bias Assessment Tool.ResultsWe screened 3608 studies and 39 studies met our criteria. The majority of the studies (90%) were conducted in the USA and 36% were randomised controlled trials. The most commonly studied nudge intervention (46%) framed information for clinicians, often through peer comparison feedback. Nudges that guided clinical decisions through default options or by enabling choice were also frequently studied (31%). Information framing, default and enabling choice nudges showed promise, whereas the effectiveness of other nudge types was mixed. Given the inclusion of non-experimental designs, only a small portion of studies were at minimal risk of bias (33%) across all Cochrane criteria.ConclusionsNudges that frame information, change default options or enable choice are frequently studied and show promise in improving clinical decision-making. Future work should examine how nudges compare to non-nudge interventions (eg, policy interventions) in improving healthcare.

scholarly journals Dental Composite Restorations Repair: A Systematic Review and Meta-analysis

2021 ◽  
pp. 707-738
Author(s):  
Abdulmohsen Al Rabiah ◽  
Alamri Zahrah ◽  
Tuwaym Malath ◽  
Al Daghri Ebtihal ◽  
Al Suhaibani Daniyah ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Prospective Cohort ◽  
Randomized Clinical Trials ◽  
Assessment Tool ◽  
Risk Of Bias ◽  
Dental Composite ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Bias Assessment

Background: Controversy exists in the literature regarding the most optimal repair procedure for improving the adhesion between the repair resin and the existing resin composite materials. Hence the aim of the present study was to do a systematic review and to analyze the adhesion potential of resin-based composites to similar and dissimilar composites and aimed to determine the possible dominant factors affecting the bond strength results. Materials & Methods: Randomized clinical trials (RCTs) and prospective cohort design were searched through electronic databases including MEDLINE, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials for randomized clinical trials (RCTs) until July 2020 that compared different methods of composite restoration repair and a minimum mean follow-up time of 1 year. There were no restrictions on a particular treatment indication or outcome measures. Two authors independently conducted screening, risk of bias assessment, and data extraction of eligible trials in duplicate. We applied the Cochrane risk of bias assessment tool to consider the risk of bias. Results: We identified 10 articles; two of them were RCTs, and eight prospective cohort studies. There were 530 participants, with 990 teeth, dealing with resin-based composite (RBC) restorations. The intervention of defective restorations ranged from minimal intervention to total restoration replacement. The evaluation criteria were also varied with different evaluation protocols. The low number and heterogeneity of RCTs did not allow for meta-analyses. Conclusions: Although different repair protocols are mentioned in the literature according to the included studies, an appropriate and definitive conclusion can't be drawn. However, it seems repairs versus replacements should be considered as the first line of treatment when all factors lead to repair rather than replacement. Further randomized controlled trials with high methodological quality need to be conducted in order to establish evidence-based recommendations, particularly for RBC repair.

scholarly journals Detection of intracranial hypertension in children using optical coherence tomography: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046935
Author(s):  
Sohaib R Rufai ◽  
Michael Hisaund ◽  
Noor ul Owase Jeelani ◽  
Rebecca J McLean
Keyword(s):  
Systematic Review ◽  
Optical Coherence Tomography ◽  
Intracranial Hypertension ◽  
Assessment Tool ◽  
Retinal Nerve Fibre Layer ◽  
Cochrane Central Register ◽  
Optical Coherence ◽  
Diagnostic Capability ◽  
Registration Number ◽  
Nerve Fibre Layer

ObjectivesTo evaluate the diagnostic capability of optical coherence tomography (OCT) in children aged under 18 years old with intracranial hypertension (IH).DesignSystematic review.MethodsWe conducted a systematic review using the following platforms to search the keywords ‘optical coherence tomography’ and ‘intracranial hypertension’ from inception to 2 April 2020: Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, PubMed and Web of Science, without language restrictions. Our search returned 2729 records, screened by two independent screeners. Studies were graded according to the Oxford Centre for Evidence-Based Medicine and National Institutes of Health Quality Assessment Tool for observational studies.ResultsTwenty-one studies were included. Conditions included craniosynostosis (n=354 patients), idiopathic IH (IIH; n=102), space-occupying lesion (SOL; n=42) and other pathology (n=29). OCT measures included optic nerve parameters, rim parameters (notably retinal nerve fibre layer thickness) and retinal parameters. Levels of evidence included 2b (n=13 studies), 3b (n=4) and 4 (n=4). Quality of 10 studies was fair and 11 poor. There was inconsistency in OCT parameters and reference measures studied, although OCT did demonstrate good diagnostic capability for IH in craniosynostosis, IIH and SOL.ConclusionsThis systematic review identified various studies involving OCT to assist diagnosis and management of IH in children with craniosynostosis, IIH, SOL and other pathology, in conjunction with established clinical measures of intracranial pressure. However, no level 1 evidence was identified. Validating prospective studies are, therefore, required to determine optimal OCT parameters in this role and to develop formal clinical guidelines.PROSPERO registration numberCRD42019154254.

scholarly journals Efficacy of Acupuncture for Treating Opioid Use Disorder in Adults: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-15
Author(s):  
Zhihan Chen ◽  
Yitong Wang ◽  
Rui Wang ◽  
Jin Xie ◽  
Yulan Ren
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Sham Acupuncture ◽  
Opioid Use Disorder ◽  
Cochrane Central Register ◽  
Opioid Use ◽  
Link Type ◽  
Registration Number

Objectives. To assess the efficacy of acupuncture in treating opioid use disorder (OUD). Design. Systematic review and meta-analysis. Methods. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, ProQuest Dissertation and Theses, Allied and Complementary Medicine Database (AMED), Clinicaltrials.gov, and who.int/trialsearch were searched from inception to 23 December 2017. The methodological quality of selected studies and the quality of evidence for outcomes were assessed, respectively, by the Cochrane risk of bias assessment tool and the GRADE approach. Statistical analyses were conducted by RevMan 5.3. Results. A total of nine studies involving 1063 participants fulfilled the inclusion criteria. The results showed that acupuncture could be more beneficial than no treatment/sham acupuncture in terms of changes in craving for opioid (MD -2.18, 95% CI -3.10 to -1.26), insomnia (MD 2.31, 95% CI 1.97 to 2.65), and depression (SMD -1.50, 95% CI -1.85 to -1.15). In addition, these findings showed that, compared to sham electroacupuncture (EA), EA had differences in alleviating symptoms of craving (SMD -0.50, 95% CI -0.94 to -0.05) and depression (SMD -1.07, 95% CI -1.88 to -0.25) and compared to sham transcutaneous acupoint electrical stimulation (TEAS), TEAS had differences in alleviating symptoms of insomnia (MD 2.31, 95% CI 1.97 to 2.65) and anxiety (MD -1.26, 95% CI -1.60 to -0.92) compared to no treatment/sham TEAS. Conclusions. Acupuncture could be effective in treating OUD. Moreover, EA could effectively alleviate symptoms of craving for opioid and depression, and TEAS could be beneficial in improving symptoms of insomnia and anxiety. Nevertheless, the conclusions were limited due to the low-quality and small number of included studies. PROSPERO registration number is CRD42018085063.

scholarly journals Systematic review of prediction models for pulmonary tuberculosis treatment outcomes in adults

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044687
Author(s):  
Lauren S. Peetluk ◽  
Felipe M. Ridolfi ◽  
Peter F. Rebeiro ◽  
Dandan Liu ◽  
Valeria C Rolla ◽  
...  
Keyword(s):  
Systematic Review ◽  
Treatment Outcomes ◽  
Prediction Models ◽  
Assessment Tool ◽  
Data Extraction ◽  
External Validation ◽  
Included Study ◽  
Risk Of Bias ◽  
Pulmonary Tb ◽  
Tb Treatment

ObjectiveTo systematically review and critically evaluate prediction models developed to predict tuberculosis (TB) treatment outcomes among adults with pulmonary TB.DesignSystematic review.Data sourcesPubMed, Embase, Web of Science and Google Scholar were searched for studies published from 1 January 1995 to 9 January 2020.Study selection and data extractionStudies that developed a model to predict pulmonary TB treatment outcomes were included. Study screening, data extraction and quality assessment were conducted independently by two reviewers. Study quality was evaluated using the Prediction model Risk Of Bias Assessment Tool. Data were synthesised with narrative review and in tables and figures.Results14 739 articles were identified, 536 underwent full-text review and 33 studies presenting 37 prediction models were included. Model outcomes included death (n=16, 43%), treatment failure (n=6, 16%), default (n=6, 16%) or a composite outcome (n=9, 25%). Most models (n=30, 81%) measured discrimination (median c-statistic=0.75; IQR: 0.68–0.84), and 17 (46%) reported calibration, often the Hosmer-Lemeshow test (n=13). Nineteen (51%) models were internally validated, and six (16%) were externally validated. Eighteen (54%) studies mentioned missing data, and of those, half (n=9) used complete case analysis. The most common predictors included age, sex, extrapulmonary TB, body mass index, chest X-ray results, previous TB and HIV. Risk of bias varied across studies, but all studies had high risk of bias in their analysis.ConclusionsTB outcome prediction models are heterogeneous with disparate outcome definitions, predictors and methodology. We do not recommend applying any in clinical settings without external validation, and encourage future researchers adhere to guidelines for developing and reporting of prediction models.Trial registrationThe study was registered on the international prospective register of systematic reviews PROSPERO (CRD42020155782)

scholarly journals Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zoë Tieges ◽  
Terence Quinn ◽  
Lorn MacKenzie ◽  
Daniel Davis ◽  
Graciela Muniz-Terrera ◽  
...  
Keyword(s):  
Systematic Review ◽  
Assessment Tool ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Evaluation Framework ◽  
Cochrane Central Register ◽  
Symptom Domains ◽  
Meta Analyses ◽  
Psychotic Features ◽  
Quality Evidence

Abstract Background Delirium is a heterogeneous syndrome with inattention as the core feature. There is considerable variation in the presence and degree of other symptom domains such as altered arousal, psychotic features and global cognitive dysfunction. Delirium is independently associated with increased mortality, but it is unclear whether individual symptom domains of delirium have prognostic importance. We conducted a systematic review and meta-analysis of studies in hospitalised adults in general settings to identify the relationship between symptom domains of delirium and outcomes. (PROSPERO: CRD42018093935). Methods We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials from inception to November 2019. We included studies of hospitalised adults that reported associations between symptom domains of delirium and 30-day mortality (primary outcome), and other outcomes including mortality at other time points, length of stay, and dementia. Reviewer pairs independently screened articles, extracted data, and assessed risk of bias (Risk of Bias Assessment tool for Non-randomized Studies) and quality of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. We performed random-effects meta-analyses stratified by delirium domain where possible. Results From 7092 citations we included 6 studies (6002 patients, 1112 with delirium). Higher mortality (ranging from in-hospital to follow-up beyond 12 months) was associated with altered arousal (pooled Odds Ratio (OR) 2.80, 95% Confidence Interval (CI) 2.33–3.37; moderate-quality evidence), inattention (pooled OR 2.57, 95% CI 1.74–3.80; low-quality evidence), and in single studies with disorientation, memory deficits and disorganised thoughts. Risk of bias varied across studies but was moderate-to-high overall, mainly due to selection bias, lack of blinding of assessments and unclear risk of selective outcome reporting. We found no studies on the association between psychotic features, visuospatial deficits or affective disturbances in delirium and outcomes, or studies reporting non-mortality outcomes. Conclusions Few studies have related symptom domains of delirium to outcomes, but the available evidence suggests that altered arousal and inattention in delirium are associated with higher mortality than normal arousal and attention in people with or without delirium. Measurable symptom domains of delirium may have value in predicting survival and stratifying patients for treatment. We recommend that future delirium studies report outcomes by symptom domain.

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