ABSTRACT
BACKGROUND: Post-operative delirium (POD) is associated with higher rates of functional decline and death. Ondansetron is a serotonin antagonist which could represent a therapeutic or preventive option in POD. METHODS: A systematic review of MEDLINE, EMBASE, CENTRAL, and PsychINFO was performed. Three randomized controlled trials (RCTs) met inclusion criteria (intervention of ondansetron compared to a control group). RESULTS: Two RCTs examined ondansetron for the treatment of POD in patients after cardiac or post-trauma surgery in the ICU. Studies assessed either a one-time dose or doses for 3 days of ondansetron or haloperidol IV. They suggested similar reductions in average delirium scores and rates in both interventions, although one study suggested ondansetron to be associated with higher rates of rescue haloperidol use. One RCT examined prophylactic ondansetron versus placebo IV, for five days postoperatively, to prevent POD in orthopedic patients. There were significantly fewer delirious patients in the ondansetron group. In general, studies had major methodological limitations and were very heterogenous in study tools, interventions used, and populations studied. CONCLUSIONS: Ondansetron may be an effective agent for the prevention or treatment of POD, but studies are few and of poor quality, thus making the conclusions tenuous. Further large RCTs are needed.
ABSTRACT
BACKGROUND: Canada has a growing multinational immigrant population. Many commonly used cognitive assessment tools have known cultural biases and are difficult to use in ethnically diverse patient populations. The Rowland Universal Dementia Assessment Scale (RUDAS) is a cognitive assessment tool that was created for culturally and linguistically diverse populations. We performed a systematic review and meta-analysis to assess the psychometric characteristics of the RUDAS and to compare it with other available tools. METHODS: We identified studies that assessed the psychometric properties of the RUDAS compared with a reference standard for diagnosing dementia or compared the RUDAS to other cognitive assessment tools. Two independent reviewers screened the abstracts and full-text articles and reviewed bibliographies for further references. We extracted data using standardized forms and assessed studies for risk of bias. RESULTS: Our search resulted in 148 articles, from which 11 were included. The RUDAS was assessed in 1236 participants and was found to have a pooled sensitivity of 77.2% (95% confidence interval [CI] 67.4-84.5) and a pooled specificity of 85.9% (95% CI 74.8-92.6) yielding a positive likelihood ratio of 5.5 (95% CI 2.9-10.7) and a negative likelihood ratio of 0.27 (95% CI 0.17-0.40). A pooled estimate of the correlation between the RUDAS and the Mini-Mental State Examination (MMSE) was 0.77 (95% CI 0.72-0.81). Results of the RUDAS were less affected by language and education level than the MMSE. INTERPRETATION: The RUDAS is a brief and freely available cognitive assessment tool with reasonable psychometric characteristics that may be particularly useful in patients with diverse backgrounds.
