The authors did not explicitly report inclusion and exclusion criteria, but it was apparent from the clinical question and search strategy that randomised controlled trials (RCTs) evaluating antipsychotic prophylaxis for the prevention of post-operative delirium in at risk elderly patients were eligible for inclusion in the review.
The included study was a prospective, randomised, double-blind, placebo-controlled trial looking at low-dose haloperidol prophylaxis for delirium prevention in elderly patients waiting for non-elective hip surgery. Dose and duration of oral haloperidol was 0.5 mg (three times daily) for up to 72 hours pre-operatively and for three days post-operatively. If delirium occurred, participants received haloperidol (three times daily daily) or lorazepam (or both) administered according to hospital protocol. Included participants were recruited from orthopaedic and surgical departments at a large hospital in the Netherlands.
Delirium risk was assessed based on four risk factors (visual impairment, severity of illness, cognitive impairment and index of dehydration) and categorised as no/low risk (0 risk factors), intermediate risk (1-2 risk factors) or high risk (3-4 risk factors). Patients assessed as having no risk factors were excluded. Patients with a history of Parkinsonism or epilepsy, current delirium, use of cholinesterase inhibitors, levodopa treatment and prolonged QTc interval on electrocardiogram were excluded from the study.
The primary outcome was presence or absence of post-operative delirium as defined by Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) and Confusion Assessment Method (CAM). Secondary outcomes included: delirium severity using Delirium Rating Scale, revised version-98 (DSR-R-98); duration of delirium; and length of hospital stay. Intervention adherence and adverse events were also recorded.
The authors stated neither how the papers were selected for the review nor how many reviewers performed the selection.