Society guideline links: Adult with altered mental status in the emergency department

Introduction — This topic includes links to society and government-sponsored guidelines from selected countries and regions around the world. We will update these links periodically; newer versions of some guidelines may be available on each society's website. Some societies may require users to log in to access their guidelines.

The recommendations in the following guidelines may vary from those that appear in UpToDate topic reviews. Readers who are looking for UpToDate topic reviews should use the UpToDate search box to find the relevant content.

Links to related guidelines are provided separately. (See "Society guideline links: Cognitive impairment and dementia" and "Society guideline links: Delirium and confusional states in older adults".)

Canada

●Choosing Wisely Canada: Don't routinely obtain head computed tomography (CT) scans, in hospitalized patients with delirium in the absence of risk factors (updated 2021)

●Choosing Wisely Canada: Don't use benzodiazepines and other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium (updated 2021)

●Choosing Wisely Canada: Don't use restraints with older persons unless all other alternatives have been explored (updated 2020)

United States

●American College of Emergency Physicians (ACEP): Clinical policy – Critical issues in the evaluation and management of adult out-of-hospital or emergency department patients presenting with severe agitation (2023)

●ACEP: Policy statement on use of patient restraints (1991, revised 2020)

●American College of Radiology (ACR): ACR Appropriateness Criteria on acute mental status change, delirium, and new onset psychosis (2018)

●ACEP: Clinical policy – Critical issues in the diagnosis and management of the adult psychiatric patient in the emergency department (2017)

●ACEP, American Geriatrics Society (AGS), Emergency Nurses Association (ENA), Society of Academic Emergency Medicine (SAEM): Geriatric emergency department guidelines (2014)

●American Association for Emergency Psychiatry (AAEP): Consensus statement on the psychopharmacology of agitation (2012)

United Kingdom

●Royal College of Emergency Medicine (RCEM): Best practice guideline – Acute behavioural disturbance in emergency departments (2022)

●British Geriatrics Society (BGS): Silver Book II – Quality care for older people with urgent care needs (2021)

●Scottish Intercollegiate Guidelines Network (SIGN): Risk reduction and management of delirium – A national clinical guideline (2019)

●Choosing Wisely UK: Royal College of Psychiatrists – Do not use physical restraints in older adults in hospital settings with delirium except as a last resort (2018)

●National Institute for Health and Care Excellence (NICE): Guideline on violence and aggression – Short-term management in mental health, health and community settings (2015)

Australia–New Zealand

●Australasian College for Emergency Medicine (ACEM): Policy statement on violence in emergency departments (2021)

●Choosing Wisely Australia: Do not prescribe benzodiazepines or other sedative-hypnotics to older adults as first choice for insomnia, agitation or delirium (reviewed 2016)

●Choosing Wisely Australia: Do not use physical restraints to manage behavioural symptoms of hospitalized older adults with delirium except as a last resort (reviewed 2016)