Systematic ReviewResearchMedication SafetyQuality Improvement

Delirium affected about one in ten older emergency patients across 16 studies

Medicine (PubMed)Aug 7, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A systematic review of 16 observational studies involving 31,543 older emergency patients estimated delirium prevalence at about 10% and identified age, baseline cognitive impairment, and medication-related exposures as associated risk markers.

What NurseJet pulled from the source

The meta-analysis included comparative studies that used validated delirium tools or diagnostic criteria in emergency patients aged 65 years or older. Baseline cognitive impairment or dementia had the largest reported pooled association, but heterogeneity was substantial and the authors caution that the findings are risk markers rather than causal effects.

Why this matters for nurses

Emergency nurses are positioned to notice acute inattention, altered arousal, and fluctuation early, yet delirium can be missed when the baseline is unknown. The review supports deliberate risk recognition and validated assessment without treating any single factor as diagnostic.

Bedside takeaway

Combine baseline collateral, validated delirium assessment, medication review, and escalation of acute or fluctuating cognitive change.

How This Applies in Practice

Use this when: Assessing an emergency patient aged 65 years or older, especially when cognition, arousal, or behavior differs from baseline.

On your shift

Seek collateral information about baseline cognition, function, communication, sensory needs, and the timing and fluctuation of the change.
Complete the approved delirium assessment and review medication exposure, pain, oxygenation, infection, hydration, elimination, and other acute contributors.
Escalate new inattention, altered arousal, or fluctuating cognition and document safety, observation, orientation, and reassessment needs.

Keep in mind: Risk factors are not diagnostic and observational associations are not causal. Follow the emergency delirium protocol, facility policy, and provider orders.

Key takeaways

Sixteen comparative observational studies included 31,543 emergency patients aged 65 years or older.
Pooled delirium prevalence was approximately 10%.
Baseline cognitive impairment or dementia was associated with delirium, with a pooled odds ratio of 1.90.
Advanced age and medication-related exposures were also associated, but several pooled domains had substantial heterogeneity.

Practice implications

Obtain collateral baseline cognition and function when possible, complete the approved delirium assessment, and review medication exposure and acute contributors when an older patient changes. Escalate acute or fluctuating findings while maintaining safety, orientation, sensory support, and observation needs.

Limitations & cautions

All included studies were observational, adjusted estimates were not available for every factor, and substantial heterogeneity affected several domains. Functional dependence and emergency-process factors were not statistically significant in pooled analyses, and associations cannot establish that a risk marker caused delirium.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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Medicine (PubMed)

Medicine (PubMed). Risk factors associated with delirium in older emergency department patients: A systematic review and meta-analysis.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42566629/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Renal failure (PubMed)Sep 7, 2026Research Article

A single-center retrospective cohort found that approximately one quarter of laboratory-defined acute kidney injury cases on internal medicine wards were not documented, particularly when maximal creatinine was lower.

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Research ArticleResearchQuality ImprovementAI summary · original source linked below

Among 161 adult hospitalizations meeting serum-creatinine criteria for acute kidney injury, 39 cases (24.2%) were undocumented. Length of stay and in-hospital mortality did not differ significantly by documentation status.

Key takeaways

In the 149 hospitalizations with a demonstrable creatinine change, 33 cases (22.1%) were undocumented.
Higher maximal creatinine was associated with lower adjusted odds of underdocumentation.
The study did not test whether a detection or documentation intervention improves care or outcomes.

Why this matters on shift

A smaller creatinine rise may receive less attention even when it meets the study's laboratory definition of acute kidney injury, which can affect how renal risk is communicated across the inpatient team.

Bedside takeaway

Trend ordered renal-function results and communicate clinically important changes through local escalation and documentation workflows.

Nursing implications

Trend ordered renal-function results and communicate clinically important changes through the care team according to local escalation and documentation workflows.

Limitations & cautions

Abstract-only summary. This was a retrospective, single-center study of 161 hospitalizations; urine-output criteria and reliable preadmission creatinine values were unavailable, and the reference creatinine method may affect case classification.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Renal failure (PubMed). Underdocumentation of laboratory-defined acute kidney injury in internal medicine wards: a retrospective cohort study.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Pediatric emergency care (PubMed)Sep 7, 2026Research Article

A double-blind randomized trial found no reduction in vomiting or faster oral tolerance with intravenous pantoprazole versus placebo in children with acute gastroenteritis and persistent vomiting after ondansetron.

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Research ArticleResearchMedication SafetyAI summary · original source linked below

The trial randomized 100 children. Vomiting episodes and oral tolerance at 6 and 12 hours did not differ significantly, while median hospital stay was 2 days with pantoprazole and 1 day with placebo.

Key takeaways

The median participant age was 14 months, and 67% of participants were male.
Oral tolerance at 12 hours was 86% in both groups.
The longer stay associated with pantoprazole requires cautious interpretation because this was a single-center trial.

Why this matters on shift

The trial does not support empiric intravenous proton-pump inhibition for persistent vomiting in pediatric acute gastroenteritis after ondansetron.

Bedside takeaway

Clarify the indication for empiric acid suppression and keep hydration and oral-tolerance assessment central to care.

Nursing implications

Prioritize the ordered hydration and oral-tolerance plan, document ongoing emesis, and clarify the indication before administering empiric acid suppression.

Limitations & cautions

Abstract-only summary. This was a single-center study of 100 children in Tehran, and the abstract does not describe adverse events or explain why hospitalization was longer in the pantoprazole group.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatric emergency care (PubMed). Effect of Intravenous Pantoprazole on Clinical Outcomes in Pediatric Acute Gastroenteritis: A Placebo-Controlled RCT.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

European heart journal (PubMed)Sep 6, 2026Research Article

In the pragmatic TARGET-D randomized trial, vitamin D dosing titrated to a serum target did not significantly reduce the composite of death, recurrent myocardial infarction, heart-failure hospitalization, or stroke after myocardial infarction.

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Research ArticleResearchMedication SafetyPatient EducationAI summary · original source linked below

Among 630 participants followed for an average of 4.2 years, major cardiovascular events occurred in 15.7% with targeted vitamin D management and 18.4% with usual care (hazard ratio 0.85, 95% CI 0.58 to 1.24; P=0.40).

Key takeaways

At baseline, 87% of participants had a 25-hydroxyvitamin D level of 40 ng/mL or lower.
The primary composite outcome and the individual outcomes of death, heart-failure hospitalization, and stroke were not significantly different.
A lower recurrent-MI rate was a secondary finding and should not override the nonsignificant primary result.

Why this matters on shift

The trial cautions against presenting targeted vitamin D supplementation as a proven strategy for reducing major cardiovascular events after myocardial infarction.

Bedside takeaway

Present vitamin D as prescribed supplementation, not as a replacement for established post-MI secondary prevention.

Nursing implications

Reinforce the prescribed secondary-prevention plan and avoid implying that vitamin D replaces therapies with established post-MI benefit.

Limitations & cautions

Abstract-only summary. The trial included 630 participants, 78.1% were men, the primary confidence interval included benefit and no benefit, and individual secondary outcomes were not the primary endpoint.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

European heart journal (PubMed). Targeted vitamin D supplementation and major adverse cardiovascular events after myocardial infarction: the TARGET-D trial.

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

One in four laboratory-defined AKI cases went undocumented on medicine wards

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Targeted vitamin D did not significantly reduce major cardiovascular events after MI