# Delirium Clinical Practice Guidelines: What Do We Know, and What Should We Do? About This Podcast Dr. Danya Khoujah joins GEMCast host Dr. Christina to dive into the first clinical practice guideline in the Geriatric Emergency Department (GED) Guidelines 2.0, which is dedicated to delirium. Delirium is a clinical syndrome characterised by acute and fluctuating disturbances of attention, awareness, perception or consciousness and it commonly affects older adults presenting to the ED. However, it is often missed, which has significant impacts on mortality and functional status of older patients. Khoujah is an attending physician in the Department of Emergency Medicine at AdventHealth Tampa in Florida, and host of GEDC’s expert-panel webinars. She is part of the multidisciplinary team that created this GRADE-based clinical guideline, and in this episode, she talks through the development and recommendations arising from the guideline. The group aimed to assess the quality and applicability of direct and indirect evidence, with the goal of providing ED clinicians a patient-centred approach to delirium. To do so they asked 3 key questions: Which older patients in the ED are at higher risk of delirium? Which diagnostic tests are effective at identifying ED delirium? Do older ED patients with delirium need a CT head? Play the Episode Tune in to today’s episode to hear more about risk stratification, screening, diagnosing and brain imaging for delirium in the ED, and keep an eye out for upcoming clinical guidelines in the GED Guidelines 2.0 series including medication safety, fall prevention, dementia, elder abuse and frailty. https://youtu.be/RTqmdAnenzA Subscribe on YouTube Subscribe on iTunes Key Points The GRADE approach is a rigorous and systematic framework that is considered gold-standard for guideline creation. More high-quality minimally biased ED-based delirium research is needed. Due to the lack of current evidence, there is low certainty for the 6 recommendations included in the guideline. Risk Stratification Using screening tools to identify patients at risk of delirium can help focus resources, including diagnostic testing and preventative measures, on the most vulnerable patients. Scoring should be an efficient and realistic process, and the components of a risk score should ideally be EMR-based so that scores can be auto-populated. The 3 screening tools below are recommended by the guideline. A score < 1 identifies older adults as low risk for delirium in the ED. This can be used in a similar way to the PERC for pulmonary embolism. 3 elements: dementia, functional dependence (Katz Activities of Daily Living ≤ 4), and hearing impairment. Read Study This can be used to identify patients at low or high risk of delirium for adults aged over 65 that are admitted to an ED observation unit from the ED. A score < 4 is considered low-risk for delirium and a score ≥ 4 is considered high-risk. Read Study This can be used for adults over age 75 in the ED to identify patients at low or high risk of delirium. A score < 11 is considered low-risk for delirium and a score ≥ 11 is considered high-risk. A score < 5 rules out high-risk for delirium. Read Study Diagnostic Tools in the ED The guidelines recommend to rule delirium in or out there are several brief and easy-to-use bedside diagnostic tools such as the 4AT, bCAM, CAM-ICU, mCAM, AMT-4, or RASS. To rule out delirium the Delirium Triage Screen (DTS) may be used. The 4AT has the largest quantity of ED-based research. The bCAM is made for the ED and highly specific. Brain Imaging Unfortunately, there was insufficient evidence to recommend for, or against, ordering a head CT. There is no clear guidance on ordering head CTs in older ED patients presenting with delirium, and there are no studies on the association between delirium diagnosis and abnormal findings on head CTs. There is high utilization of head CTs for altered mental status. Academic Emergency Medicine | October 27, 2025 GRADE-Based Clinical Practice Guidelines for Emergency Department Delirium Risk Stratification, Screening, and Brain Imaging in Older Patients With Suspected Delirium Explore the full guidelines for more comprehensive recommendations related to suspected delirium in the older ED patient. Read Article GEAR Geriatric Emergency Department 2.0 Guidelines View Website Next, listen to Caring for the Caregiver: How the ED Can Support Caregivers of Patients with Dementia with Dr. Cameron Gettel. Play Episode View All Delirium Resources >