An evaluation of two screening tools for cognitive impairment in older emergency department patients
cognitive impairment; delirium; elderly emergency; Emergency department; Emergency Medicine; Examination; mental status; Mini-Cog; Mini-Mental State; prevalence; Six-Item Screener
Objectives: Screening for cognitive impairment in older emergency department (ED) patients is recommended to ensure quality care. The Mini-Mental State Examination (MMSE) may be too long for routine ED use. Briefer alternatives include the Six-Item Screener (SIS) and the Mini-Cog. The objective of this study was to describe the test characteristics of the SIS and the Mini-Cog compared with the MMSE when administered to older ED patients. Methods: This institutional review board-approved, prospective, randomized study was performed in a university-affiliated teaching hospital ED. Eligible patients were 65 years and older and able to communicate in English. Patients who were unable or unwilling to perform testing, who were medically unstable, or who received medications affecting their mental status were excluded. Patients were randomized to receive the SIS or the Mini-Cog by the treating emergency physician. Investigators administered the MMSE 30 minutes later. An SIS score of <= 4, the Mini-Cog's scoring algorithm, and an MMSE score of <= 23 defined cognitive impairment. Results: A total of 149 of 188 approached patients were enrolled; 74 received the SIS and 75 the Mini-Cog. Fifty-five percent were female, the average age was 75 years, and 23% had an MMSE score of <= 23. The SIS had a sensitivity of 94% (95% confidence interval [CI] = 73% to 100%) and a specificity of 86% (95% CI = 74% to 94%). The Mini-Cog had a sensitivity of 75% (95% CI = 48% to 93%) and a specificity of 85% (95% CI = 73% to 93%). Conclusions: The SIS, using a cutoff of <= 4 as impaired, is a promising test for ED use. It is short, easy to administer, and unobtrusive, allowing it to be easily incorporated into the initial assessment of older ED patients.
Wilber S T; Lofgren S D; Mager T G; Blanda M; Gerson L W
Academic Emergency Medicine
2005
2005-07
Journal Article
<a href="http://doi.org/10.1111/j.1553-2712.2005.tb00915.x" target="_blank" rel="noreferrer noopener">10.1111/j.1553-2712.2005.tb00915.x</a>
The National Emergency Medicine Fourth-year Student (M4) Examinations: Updates and Performance.
*Education; assessment; CDEM; Clinical Clerkship; Clinical Competence; Education; Educational Measurement; Educational Measurement/*methods; Emergency Medicine – Education; Emergency Medicine/*education; examination; Humans; Medical; medical student; Undergraduate
BACKGROUND: Version 1 (V1) of the National Emergency Medicine Fourth-year Student (EM M4) Examination was released in 2011 and revised along with release of V2 in 2012. Each examination contains 50 multiple-choice questions designed to assess knowledge in the EM M4 clerkship curriculum. Development and initial performance data were described previously. OBJECTIVE: To provide updated V1 performance data, describe development and revision of V2, and to compare performance between academic years and examination forms, and within academic years. METHODS: Examinations are administered at www.saemtests.org with ongoing performance data provided. After 1 year of use, nine questions on V2 were revised, five because of low discriminatory ability and four because of excessive difficulty. Revision or replacement was done in accordance with the National Board of Medical Examiners (NBME) Item Writing Guidelines. Mean scores were compared for V1 between academic years (i.e., July 2011-June 2012 vs. July 2012-June 2013), V2 compared with V1, and for each examination version for early and late test takers. RESULTS: V1 has been administered \textgreater10,000 times since its release, and the current form mean is 81.5% (SD 3.7). Average discriminatory value (rpb) is 0.204. V2 has been administered \textgreater1500 times, with a mean score of 78.4% (SD 4.4) and average rpb 0.253. V1 and V2 current means differ statistically. Scores from examinees completing V1 or V2 early vs. late in the academic year differ statistically. CONCLUSIONS: Performance data for V1 remain stable after 2 years. Revisions of poorly performing questions improved question performance on V2. Questions with low rpb or low pdiff will continue to be revised annually. While examination forms differ statistically, the practical utility of the differences is not defined.
Heitz Corey R; Lawson Luan; Beeson Michael; Miller Emily S
The Journal of emergency medicine
2016
2016-01
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/10.1016/j.jemermed.2015.06.072" target="_blank" rel="noreferrer noopener">10.1016/j.jemermed.2015.06.072</a>