Diagnosis, Prevention, Management, and Prognostication of Delirium in Acute-Care Neurosurgical Patients: A Systematic Scoping Review

Delirium represents a frequent and serious complication in neurosurgical patients, contributing to worse clinical outcomes and increased healthcare burden, yet evidence specific to this population remains fragmented. This scoping review systematically mapped literature on diagnosis, prevention, management, and prognostication of delirium in adult neurosurgical patients, including both surgical and nonsurgical settings, to identify knowledge gaps and inform future research and practice. Following JBI methodology and PRISMA-ScR guidelines, PubMed, MEDLINE, Scopus, and Web of Science were searched for studies published between January 2000 and November 2024. Of 4519 records screened, 102 studies met inclusion criteria. Reported delirium incidence varied widely (0.47-85%), with higher rates in cranial compared with spinal populations. Diagnosis relied mainly on validated screening tools such as the Confusion Assessment Method, while emerging approaches-including structured fluctuation-based assessments, electroencephalography, and pupillometry-showed potential for improved detection. Preventive evidence was limited; dexmedetomidine use, goal-directed fluid therapy, and early frailty-focused rehabilitation were associated with reduced incidence. Management data were scarce, with only two small randomized trials suggesting benefit from nonpharmacological family-environmental interventions and dexmedetomidine compared with haloperidol. Most studies focused on prognostication, identifying consistent risk factors such as preoperative cognitive impairment, frailty, sleep disruption, intraoperative hemodynamic instability, transfusion, and inflammatory or neuronal biomarkers. Across settings, delirium was associated with prolonged hospitalization, long-term cognitive decline, increased mortality, and greater influence on end-of-life decision-making. Overall, current evidence emphasizes risk identification rather than intervention. Significant gaps persist in neurosurgery-specific diagnostic tools, validated preventive bundles, and effective treatment strategies. Future research should prioritize the development and validation of tailored, multimodal approaches to enable personalized delirium care in neurosurgical populations.