Delirium after surgery and in the intensive care unit (ICU) remains a challenge for patients, families, and caregivers. Over the years, many promising biomarkers have been investigated as potential instruments for risk stratification of delirium. This review aimed to identify and assess the clinical usefulness of candidate serum biomarkers associated with hospital delirium in patients aged 60 years and older. We performed a time-unlimited review of publications indexed in PubMed, Cochrane, Embase, and MEDLINE databases until June 2019 that evaluated baseline and/or longitudinal biomarker measurements in patients suffering from delirium at some point during their hospital stay. A total of 32 studies were included in this review reporting information on 7610 patients. Of these 32 studies, twentyfour studies reported data from surgical patients including four studies in ICU cohorts, five studies reported data from medical patients (1026 patients), and three studies reported data from a mixed cohort (1086 patients), including one study in an ICU cohort. Findings confirm restricted clinical usefulness to predict or diagnose delirium due to limited evidence on which biomarkers can be used and limited availability due to non-routine use.

IntroductionDelirium is frequently observed in the intensive care unit (ICU) population, in particular. Until today, there is no evidence for any reliable pharmacological intervention to treat delirium. The Basel BOMP-AID (BetterOutcome withMelatonin compared toPlaceboAdministered to normalize sleep-wake cycle and treat hypoactiveICUDelirium) randomised trial targets improvement of hypoactive delirium therapy in critically ill patients and will be conducted as a counterpart to the Basel ProDex Study (Study Protocol, BMJ Open, July 2017) on hyperactive and mixed delirium. The aim of the BOMP-AID trial is to assess the superiority of melatonin to placebo for the treatment of hypoactive delirium in the ICU. The study hypothesis is based on the assumption that melatonin administered at night restores a normal circadian rhythm, and that restoration of a normal circadian rhythm will cure delirium.Methods and analysisThe Basel BOMP-AID study is an investigator-initiated, single-centre, randomised controlled clinical trial for the treatment of hypoactive delirium with the once daily oral administration of melatonin 4 mg versus placebo in 190 critically ill patients. The primary outcome measure is delirium duration in 8-hour shifts. Secondary outcome measures include delirium-free days and death at 28 days after study inclusion, number of ventilator days, length of ICU and hospital stay, and sleep quality. Patients will be followed after 3 and 12 months for activities of daily living and mortality assessment. Sample size was calculated to demonstrate superiority of melatonin compared with placebo regarding the duration of delirium. Results will be presented using an intention-to-treat approach.Ethics and disseminationThis study has been approved by the Ethics Committee of Northwestern and Central Switzerland and will be conducted in compliance with the protocol, the current version of the Declaration of Helsinki, the International Conference on Harmonisation (ICH) of technical requirements for registration of pharmaceuticals for human use; Good Clinical Practice (GCP) or ISO EN 14155 (as far as applicable), as well as all national legal and regulatory requirements. Study results will be presented in international conferences and published in a peer-reviewed journal.Trial registration numberNCT03438526.Protocol versionClinical Study Protocol Version 3, 10.03.2019.

Objective To determine the epidemiology and risk factors of childhood injuries in Ismailia governorate Egypt. Methods This is the Egyptian chapter of the Global Childhood Unintentional Injury Surveillance study, which employed quota sampling of children 0-11 years old presenting to the Emergency Department. This surveillance was conducted in the University Hospital of Suez Canal University Egypt, for selected months in 2007. Children with an unintentional injury of both genders were enrolled in the study. Results Out of a total of 551 cases, 361 were males (66%) and 478 (34%) females. The most common external causes of injuries were falls (60%), road traffi c injuries (15%), burns (7%), poisoning (3%) and near drowning/drowning (2%). The most common sustained injuries were fractures (17%), cuts or open wounds (15%), sprains (14%) and burns (9%). The majority of patients were treated and discharged home without disability (67%), while 7.8% had long-term temporary disability that lasted for more than 6 weeks and more than 1% sustained permanent disability. There were fi ve deaths (1% proportionate mortality), all were due to falls. Few families recounted using seatbelts (2%), car air bags (0.5%), helmets (1%), child restraint seats (1%). The majority of children received care via government insurance. Conclusions The burden of childhood injuries on the university hospital in Egypt is substantial. Ongoing child injury surveillance using systematic approaches is required to identify the epidemiology of injuries, their risk factors and plan for timely interventions.