SynthesisBMC geriatrics2017
Reduced level of arousal and increased mortality in adult acute medical admissions: a systematic review and meta-analysis.
Synthesis in BMC geriatrics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
11 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Assessment and report of individual symptoms in studies of delirium in postoperative populations: a systematic review.Age and ageing · 2024Pooled it
- Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis.BMC geriatrics · 2021Pooled it
- Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method.BMC medicine · 2019Trial
- The Single Question in Delirium as a suitable tool to improve delirium detection in hospitalized older patients.European geriatric medicine · 2025Article
- Advancing specificity in delirium: The delirium subtyping initiative.Alzheimer's & dementia : the journal of the Alzheimer's Association · 2024Article
- The phenotype of delirium based on a close reading of diagnostic criteria.International journal of geriatric psychiatry · 2023Review
- Neurophysiology of male sexual arousal-Behavioral perspective.Frontiers in behavioral neuroscience · 2023Review
- Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions.Age and ageing · 2022Article
- Article
- Delirium.Nature reviews. Disease primers · 2020Review
- Assessment of Delirium Using the Confusion Assessment Method in Older Adult Inpatients in Malaysia.Geriatrics (Basel, Switzerland) · 2019Article
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
backgroundReduced level of arousal is commonly observed in medical admissions and may predict in-hospital mortality. Delirium and reduced level of arousal are closely related. We systematically reviewed and conducted a meta-analysis of studies in adult acute medical patients of the relationship between reduced level of arousal on admission and in-hospital mortality.
methodsWe conducted a systematic review (PROSPERO: CRD42016022048), searching MEDLINE and EMBASE. We included studies of adult patients admitted with acute medical illness with level of arousal assessed on admission and mortality rates reported. We performed meta-analysis using a random effects model.
resultsFrom 23,941 studies we included 21 with 14 included in the meta-analysis. Mean age range was 33.4 - 83.8 years. Studies considered unselected general medical admissions (8 studies, n=13,039) or specific medical conditions (13 studies, n=38,882). Methods of evaluating level of arousal varied. The prevalence of reduced level of arousal was 3.1%-76.9% (median 13.5%). Mortality rates were 1.7%-58% (median 15.9%). Reduced level of arousal was associated with higher in-hospital mortality (pooled OR 5.71; 95% CI 4.21-7.74; low quality evidence: high risk of bias, clinical heterogeneity and possible publication bias).
conclusionsReduced level of arousal on hospital admission may be a strong predictor of in-hospital mortality. Most evidence was of low quality. Reduced level of arousal is highly specific to delirium, better formal detection of hypoactive delirium and implementation of care pathways may improve outcomes. Future studies to assess the impact of interventions on in-hospital mortality should use validated assessments of both level of arousal and delirium.
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