Delirium in the emergency department: science or ritual? Rethinking diagnostic pathways in emergency delirium management

Delirium is an acute disturbance of attention and awareness that develops over a short period and typically fluctuates in severity. It may affect up to one-quarter of older adults presenting to the Emergency Department (ED) and is associated with increased mortality, prolonged hospital stays, and increased healthcare costs. Despite its clinical importance, delirium is frequently underrecognized, as it may manifest with subtle or nonspecific symptoms. When delirium is suspected, prompt and systematic evaluation is critical for identifying underlying etiologies, which may include infections, metabolic disturbances, structural brain pathology, or adverse drug effects. This article is hence aimed to provide a critical overview of the English-language literature published between the years 2020 and 2025 on laboratory investigations and diagnostic workup of delirium in older patients presenting to the ED.