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The effect of mental status screening on the care of elderly emergency department patients.
Ann Emerg Med. 2003 May; 41(5):678-84.AE

Abstract

STUDY OBJECTIVES

We determine the effect of screening examinations for mental status impairment on the care of elderly patients in the emergency department and prospectively assess recognition of mental status impairment by emergency physicians.

METHODS

We performed a prospective cross-sectional study. Patients were 70 years of age or older and presented to an urban teaching hospital ED over a 17-month period. Mental status impairment screening comprised the Orientation Memory Concentration examination for cognitive impairment and the Confusion Assessment Method for delirium. Emergency physicians who were blinded to the patient's screening results were interviewed to assess recognition of mental status impairment, dispositions, and referrals. Results of mental status impairment screens were then given to emergency physicians, and emergency physicians were reinterviewed regarding any change in care.

RESULTS

Two hundred seventy-one of the 327 eligible patients were enrolled. Seventy-four (27%; 95% confidence interval [CI] 22% to 33%) patients had impaired mental status. Nineteen (7%; 95% CI 4% to 11%) had delirium, and 55 (20%; 95% CI 16% to 25%) had cognitive impairment without delirium. Mental status impairment was recognized in only 28 (38%; 95% CI 27% to 50%) of 74 patients: 3 (16%; 95% CI 3% to 40%) of 19 with delirium and 25 (46%; 95% CI 32% to 59%) of 55 with cognitive impairment without delirium. Emergency physicians altered management in none of the study patients on the basis of survey results. Five (26%; 95% CI 9% to 51%) of the 19 patients with delirium were discharged to home. Of these 5 patients discharged to home with unrecognized delirium, 1 presented with fall, 2 returned 3 days later and required hospitalization, and 1 with a history of colon cancer was given a new diagnosis of metastatic disease 4 days after the initial ED visit.

CONCLUSION

Mental status impairment is highly prevalent in older ED patients. There is a lack of recognition by emergency physicians of mental status impairment in this group. Screening tools for mental status impairment in the ED did not substantially alter the care of elderly patients with mental status impairment.

Authors+Show Affiliations

Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA. husteyf@ccf.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

12712035

Citation

Hustey, Fredric M., et al. "The Effect of Mental Status Screening On the Care of Elderly Emergency Department Patients." Annals of Emergency Medicine, vol. 41, no. 5, 2003, pp. 678-84.
Hustey FM, Meldon SW, Smith MD, et al. The effect of mental status screening on the care of elderly emergency department patients. Ann Emerg Med. 2003;41(5):678-84.
Hustey, F. M., Meldon, S. W., Smith, M. D., & Lex, C. K. (2003). The effect of mental status screening on the care of elderly emergency department patients. Annals of Emergency Medicine, 41(5), 678-84.
Hustey FM, et al. The Effect of Mental Status Screening On the Care of Elderly Emergency Department Patients. Ann Emerg Med. 2003;41(5):678-84. PubMed PMID: 12712035.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of mental status screening on the care of elderly emergency department patients. AU - Hustey,Fredric M, AU - Meldon,Stephen W, AU - Smith,Michael D, AU - Lex,Carolyn K, PY - 2003/4/25/pubmed PY - 2003/6/17/medline PY - 2003/4/25/entrez SP - 678 EP - 84 JF - Annals of emergency medicine JO - Ann Emerg Med VL - 41 IS - 5 N2 - STUDY OBJECTIVES: We determine the effect of screening examinations for mental status impairment on the care of elderly patients in the emergency department and prospectively assess recognition of mental status impairment by emergency physicians. METHODS: We performed a prospective cross-sectional study. Patients were 70 years of age or older and presented to an urban teaching hospital ED over a 17-month period. Mental status impairment screening comprised the Orientation Memory Concentration examination for cognitive impairment and the Confusion Assessment Method for delirium. Emergency physicians who were blinded to the patient's screening results were interviewed to assess recognition of mental status impairment, dispositions, and referrals. Results of mental status impairment screens were then given to emergency physicians, and emergency physicians were reinterviewed regarding any change in care. RESULTS: Two hundred seventy-one of the 327 eligible patients were enrolled. Seventy-four (27%; 95% confidence interval [CI] 22% to 33%) patients had impaired mental status. Nineteen (7%; 95% CI 4% to 11%) had delirium, and 55 (20%; 95% CI 16% to 25%) had cognitive impairment without delirium. Mental status impairment was recognized in only 28 (38%; 95% CI 27% to 50%) of 74 patients: 3 (16%; 95% CI 3% to 40%) of 19 with delirium and 25 (46%; 95% CI 32% to 59%) of 55 with cognitive impairment without delirium. Emergency physicians altered management in none of the study patients on the basis of survey results. Five (26%; 95% CI 9% to 51%) of the 19 patients with delirium were discharged to home. Of these 5 patients discharged to home with unrecognized delirium, 1 presented with fall, 2 returned 3 days later and required hospitalization, and 1 with a history of colon cancer was given a new diagnosis of metastatic disease 4 days after the initial ED visit. CONCLUSION: Mental status impairment is highly prevalent in older ED patients. There is a lack of recognition by emergency physicians of mental status impairment in this group. Screening tools for mental status impairment in the ED did not substantially alter the care of elderly patients with mental status impairment. SN - 0196-0644 UR - https://www.unboundmedicine.com/medline/citation/12712035/The_effect_of_mental_status_screening_on_the_care_of_elderly_emergency_department_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0196064403001689 DB - PRIME DP - Unbound Medicine ER -