Perceived prevalence, risk factors, and reported management of delirium in critically ill emergency patients: a survey of physicians in China.

Abstract

To investigate Chinese emergency physicians' perceptions of prevalence, associated risk factors, and reported management practices for delirium in critically ill emergency department (ED) patients. A cross-sectional survey of 402 physicians from EDs across 18 Chinese provinces. Physician-estimated delirium prevalence varied widely (median: 15%; interquartile range: 10%-30%), with most perceiving higher incidence during night shifts. Key perceived risk factors included metabolic disorders, pre-existing cognitive impairment, shock, and severe infections. Clinical judgment was the most common assessment method; structured screening tools were reportedly used infrequently. Pharmacological interventions were the preferred management approach for most respondents. This survey highlights Chinese emergency physicians' varied perceptions of delirium prevalence and reliance on clinical judgment over standardized assessment. Findings suggest a need for enhanced training in standardized screening, greater emphasis on non-pharmacological interventions, and fostering interprofessional collaboration to improve care for ED patients with or at risk of delirium. Key messages What is already known on this topic: Delirium is a serious acute neurocognitive syndrome with high Intensive Care Unit prevalence (31.8%-70%) and significant adverse outcomes. Emergency department delirium remains under recognized despite 6%-38% prevalence in older adults. International guidelines recommend non-pharmacological interventions as first-line management. What this study adds: This survey provides the first assessment of Chinese emergency physicians' delirium perceptions in critically ill patients. Key findings reveal predominant reliance on clinical judgment rather than validated tools and a preference for pharmacological interventions, particularly benzodiazepines, which conflicts with international guidelines. Substantial variation exists in perceived prevalence estimates. How this study might affect research, practice, or policy: Findings inform targeted educational initiatives for Chinese emergency departments, emphasizing the need for standardized screening training and non-pharmacological intervention promotion. Future research should prioritize objective epidemiological studies to validate perceived prevalence rates and evaluate protocol implementation.