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An Evaluation of Two Screening Tools for Cognitive Impairment in Older Emergency Department Patients
Author(s) -
Wilber Scott T.,
Lofgren Samuel D.,
Mager Thomas G.,
Blanda Michelle,
Gerson Lowell W.
Publication year - 2005
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1197/j.aem.2005.01.017
Subject(s) - medicine , emergency department , confidence interval , cog , cognitive impairment , prospective cohort study , randomized controlled trial , emergency medicine , disease , psychiatry , artificial intelligence , computer science
Abstract 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.