The Six-item Screener to Detect Cognitive Impairment in Older Emergency Department Patients.
Female; Male; Aged; Sensitivity and Specificity; Prospective Studies; ROC Curve; Geriatric Assessment; Academic Medical Centers; Confidence Intervals; Psychological Tests; Human; Cross Sectional Studies; Emergency Service; Cognition Disorders – Diagnosis; Emergency Medicine – Equipment and Supplies
BACKGROUND: Cognitive impairment due to delirium or dementia is common in older emergency department (ED) patients. To prevent errors, emergency physicians (EPs) should use brief, sensitive tests to evaluate older patient's mental status. Prior studies have shown that the Six-Item Screener (SIS) meets these criteria. OBJECTIVES: The goal was to verify the performance of the SIS in a large, multicenter sample of older ED patients. METHODS: A prospective, cross-sectional study was conducted in three urban academic medical center EDs. English-speaking ED patients \textgreater or = 65 years old were enrolled. Patients who received medications that could affect cognition, were too ill, were unable to cooperate, were previously enrolled, or refused to participate were excluded. Patients were administered either the SIS or the Mini-Mental State Examination (MMSE), followed by the other test 30 minutes later. An MMSE of 23 or less was the criterion standard for cognitive impairment; the SIS cutoff was 4 or less for cognitive impairment. Standard operator characteristics of diagnostic tests were calculated with 95% confidence intervals (CIs), and a receiver operating characteristic curve was plotted. RESULTS: The authors enrolled 352 subjects; 111 were cognitively impaired by MMSE (32%, 95% CI = 27% to 37%). The SIS was 63% sensitive (95% CI = 53% to 72%) and 81% specific (95% CI = 75% to 85%). The area under the receiver operating characteristic curve was 0.77 (95% CI = 0.72 to 0.83). CONCLUSIONS: The sensitivity of the SIS was lower than in prior studies. The reasons for this lower sensitivity are unclear. Further study is needed to clarify the ideal brief mental status test for ED use.
Wilber S T; Carpenter CR; Hustey FM
Academic Emergency Medicine
2008
2008-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1111/j.1553-2712.2008.00158.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2008.00158.x</a>
Geriatric emergency medicine and the 2006 Institute of Medicine reports from the Committee on the Future of Emergency Care in the U.S. Health System.
Aged; United States; Outpatients; Emergency Medicine; Health Services Needs and Demand; Health Policy; Nursing Homes; Disaster Planning; Inpatients; Drugs; Health Care Delivery; Institute of Medicine (U.S.); Subacute Care; Prehospital Care; 80 and Over; Emergency Care – Trends – In Old Age; Emergency Service – Trends; Health Services for the Aged – Trends
Three recently published Institute of Medicine reports, Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services: At the Crossroads, and Emergency Care for Children: Growing Pains, examined the current state of emergency care in the United States. They concluded that the emergency medicine system as a whole is overburdened, underfunded, and highly fragmented. These reports did not specifically discuss the effect the aging population has on emergency care now and in the future and did not discuss special needs of older patients. This report focuses on the emergency care of older patients, with the intent to provide information that will help shape discussions on this issue.
Wilber S T; Gerson L W; Terrell KM; Carpenter CR; Shah MN; Heard K; Hwang U
Academic Emergency Medicine
2006
2006-12
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1197/j.aem.2006.09.050" target="_blank" rel="noreferrer noopener">10.1197/j.aem.2006.09.050</a>
Analysing the literature: A research primer for low- and middle-income countries
Social media; Evidence-based medicine; Librarian search strategies; Patient safety/QI
Effective critical appraisal of medical research requires training and practice. Evidence-based medicine provides a framework for standardised review of manuscripts of nearly any research design. Online resources and communities exist to provide free access to electronic search engines and critical appraisal of emergency medicine and non-emergency medicine research. An emerging array of Free Online Open Access medical education (FOAMed) resources also provide opportunities to observe Evidence-based medicine critical appraisal in written or audio format and to actively participate as a learner. This chapter will highlight accessible resources that provide both methodological background and virtual mentoring for readers to develop EBM skills.
Carpenter CR; Hollong B; Simon EL; Graham CA
African Journal Of Emergency Medicine
2020
1905-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1016/j.afjem.2020.04.003" target="_blank" rel="noreferrer noopener">10.1016/j.afjem.2020.04.003</a>