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The strength of the relation between delirium and mortality was expressed as risk ratios with 95% confidence intervals.We selected risk ratio as a measure of effect for the binary outcome (death) as it is less prone to artificial inflation from heterogeneity than risk difference.35 Studies with zero events were entered in the analysis to include all data and reduce bias.36 To handle studies that reported zero outcomes for mortality, we performed a series of sensitivity analyses comparing Peto, Mantel-Haenszel, and inverse variance statistical methods with fixed and random effect with 0.5 continuity correction.37 38 Inverse variance and Mantel-Haenszel methods yielded identical results; we have shown the Mantel-Haenszel data in the mortality forest plot.RDS, JIFS, and AD screened citations identified by the initial search and selected potentially relevant titles for review of abstracts.From these, RDS, JIFS, and RBS then chose articles for review of full length reports.

Data were extracted on characteristics of studies, populations sampled, identification of delirium, and outcomes.

We used the Newcastle-Ottawa Scale to assess methodological quality of included studies.

this scale has been validated for the assessment of observational studies in systematic reviews and meta-analyses.32 33 The scale evaluates three aspects of study methods: the selection of study groups (range 0-4), the comparability of groups (range 0-1), and the quality of outcome ascertainment (range 0-3).

A fourth author (RDS) verified accuracy and reliability of the abstracted data by sampling 10% of the references selected at each stage the systematic search and evaluating extracted data against the original reference; any discrepancies were resolved by discussion among authors (RBS, JIFS, AD, RDS).

If data were not reported, we planned to contact first or senior authors by email; this was not necessary as data points were readily available.

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