Clinical Question

Are antipsychotic medications effective in preventing or treating delirium in hospitalized patients?

Bottom Line

The available data indicate that antipsychotic medications are ineffective in preventing or treating delirium in hospitalized patients. Because there are concerns about falls and extrapyramidal effects with antipsychotics (not reported in this study), we should stop using them. (Level of Evidence = 1a−)

Synopsis

These authors searched several databases and a clinical trials registry to identify randomized trials and cohort studies that evaluated the use of antipsychotic medications for preventing or treating delirium in hospitalized adults. Two authors independently evaluated each study for inclusion and assessed the risk of bias among the included studies. One author adjudicated disagreements and also independently assessed a random 10% subsample of all articles. The authors excluded studies that focused exclusively on patients with dementia or substance withdrawal. They ultimately included 19 studies: seven evaluated delirium prevention after surgery and 12 evaluated delirium treatment in medical and surgical patients. Six of the prevention studies and 10 of the treatment studies were randomized trials. Three of the prevention studies and three of the treatment studies were at low risk of bias. The studies were relatively small, including between 28 and 496 patients.

In the prevention studies, the rate, duration, and severity of delirium were similar between those treated with antipsychotics and those in the control group. Additionally, the authors found no difference in the hospital lengths of stay or intensive care unit lengths of stay between patients receiving antipsychotics and patients in the control group. The authors found no difference in mortality. In addition to searching a clinical trials database, the authors report their formal evaluation detected no publication bias. Finally, the authors detected moderate to high levels of heterogeneity among the various outcomes.

Study design: Meta-analysis

Funding source: Foundation

Setting: Inpatient (any location)

Reference: NeufeldKJYueJRobinsonTNInouyeSKNeedhamDMAntipsychotic medication for prevention and treatment of delirium in hospitalized adults: a systematic review and meta-analysis. J Am Geriatr Soc2016;64(4):705–714.