Delirium, Confusion, or Altered mental status as a risk for abnormal head computed tomogram findings in older adults in the emergency department: A systematic review and meta-analysis

Background Delirium, confusion, and altered mental status are common presentations among older adults to the emergency department (ED). We aimed to report the association between delirium, confusion or altered mental status in older ED patients and acute abnormal findings on head computed tomogram (CT). Methods A systematic review was conducted using Ovid Medline, Embase, Clinicaltrials.gov , Web of Science, and Cochrane Central from conception to April 8th, 2021. We included citations if they described patients aged 65 years or older who received head imaging at the time of ED assessment, and reported whether or not patients had delirium, confusion, or altered mental status. Screening, data extraction, and bias assessment were performed in duplicate. We estimated the odds ratios (OR) for abnormal neuroimaging in patients with altered mental status. Results The search strategy identified 3,014 unique citations, of which two studies reporting on 909 patients with delirium, confusion or altered mental status were included. No study formally assessed for delirium. The OR for abnormal head CT findings in patients with delirium, confusion or altered mental status was 0.35 (95% CI 0.031 to 3.97) compared to patients without delirium, confusion or altered mental status. Conclusion We did not find a statistically significant association between delirium, confusion or altered mental status and abnormal CT findings in older ED patients.