Use of a brief cognitive screening instrument in older patients attending emergency department – A pilot study

Abstract Background cognitive impairment is highly prevalent among older patients attending the Emergency Department (ED) and is associated with adverse outcomes. Methods we conducted a systematic review and meta-analysis to evaluate the diagnostic accuracy of cognitive screening instruments to rule out cognitive impairment in older patients in the ED. A comprehensive literature search was performed in MEDLINE, EMBASE, CINAHL and CENTRAL. A risk of bias assessment using QUADAS-2 was performed. Results 23 articles, examining 18 different index tests were included. Only seven index tests could be included in the meta-analysis. For ruling out cognitive impairment irrespective of aetiology, Ottawa 3 Day Year (O3DY) (pooled sensitivity 0.90; (95% CI) 0.71–0.97) had the highest sensitivity. Fourteen articles focused on screening for cognitive impairment specifically caused by delirium. For ruling out delirium, the 4 A’s Test (4AT) showed highest sensitivity (pooled sensitivity 0.87, 95% confidence interval (95% CI) 0.74–0.94). Conclusions high clinical and methodological heterogeneity was found between included studies. Therefore, it is a challenge to recommend one diagnostic test for use as a screening instrument for cognitive impairment in the ED. The 4AT and O3DY seem most promising for ruling out cognitive impairment in older patients attending the ED. The review protocol was registered in PROSPERO (CRD42018082509).

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Cognitive Screening Instrument

PsycTESTS Dataset ◽

10.1037/t75957-000 ◽

2020 ◽

Author(s):

Jaqueline de Carvalho Rodrigues ◽

Denise Ruschel Bandeira ◽

Jerusa Fumagalli de Salles

Keyword(s):

Screening Instrument ◽

Cognitive Screening

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Faculty Opinions recommendation of A pilot study of the vulnerable elders survey-13 compared with the comprehensive geriatric assessment for identifying disability in older patients with prostate cancer who receive androgen ablation.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1064694.517604 ◽

2007 ◽

Author(s):

Martine Extermann

Keyword(s):

Prostate Cancer ◽

Pilot Study ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Older Patients ◽

Androgen Ablation

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An open-label, single-center pilot study to test the effects of an amino acid mixture in older patients admitted to internal medicine wards

Nutrition ◽

10.1016/j.nut.2019.110588 ◽

2020 ◽

Vol 69 ◽

pp. 110588 ◽

Cited By ~ 1

Author(s):

Francesco Bellanti ◽

Aurelio Lo Buglio ◽

Elena Di Stasio ◽

Giorgia di Bello ◽

Rosanna Tamborra ◽

...

Keyword(s):

Internal Medicine ◽

Amino Acid ◽

Pilot Study ◽

Older Patients ◽

Amino Acid Mixture ◽

Acid Mixture ◽

Single Center ◽

Open Label ◽

Internal Medicine Wards

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The Feasibility and Validity of Autism Spectrum Disorder Screening Instrument: Behavior Development Screening for Toddlers (BeDevel)—A Pilot Study

Autism Research ◽

10.1002/aur.2117 ◽

2019 ◽

Vol 12 (7) ◽

pp. 1112-1128 ◽

Cited By ~ 2

Author(s):

Guiyoung Bong ◽

Jeong‐Heun Kim ◽

Yoohwa Hong ◽

Nan‐He Yoon ◽

Hyunjung Sunwoo ◽

...

Keyword(s):

Autism Spectrum Disorder ◽

Pilot Study ◽

Autism Spectrum ◽

Screening Instrument ◽

Spectrum Disorder ◽

Behavior Development

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Harnessing the Chaplain’s Capacity to Identify Unmet Palliative Needs of Vulnerable Older Adults in the Emergency Department

Journal of Palliative Care ◽

10.1177/08258597211003359 ◽

2021 ◽

pp. 082585972110033

Author(s):

Elizabeth Hamill Howard ◽

Rachel Schwartz ◽

Bruce Feldstein ◽

Marita Grudzen ◽

Lori Klein ◽

...

Keyword(s):

Emergency Department ◽

Palliative Care ◽

End Of Life Care ◽

Older Patients ◽

Chart Review ◽

Retrospective Chart Review ◽

Life Care ◽

Emergency Medicine Physician ◽

Medicine Physician ◽

One Year

Objective: To explore chaplains’ ability to identify unmet palliative care (PC) needs in older emergency department (ED) patients. Methods: A palliative chaplain-fellow conducted a retrospective chart review evaluating 580 ED patients, age ≥80 using the Palliative Care and Rapid Emergency Screening (P-CaRES) tool. An emergency medicine physician and chaplain-fellow screened 10% of these charts to provide a clinical assessment. One year post-study, charts were re-examined to identify which patients received PC consultation (PCC) or died, providing an objective metric for comparing predicted needs with services received. Results: Within one year of ED presentation, 31% of the patient sub-sample received PCC; 17% died. Forty percent of deceased patients did not receive PCC. Of this 40%, chaplain screening for P-CaRES eligibility correctly identified 75% of the deceased as needing PCC. Conclusion: Establishing chaplain-led PC screenings as standard practice in the ED setting may improve end-of-life care for older patients.

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Symptom-based early-stage differentiation between SARS-CoV-2 versus other respiratory tract infections—Upper Silesia pilot study

Scientific Reports ◽

10.1038/s41598-021-93046-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Justyna Mika ◽

Joanna Tobiasz ◽

Joanna Zyla ◽

Anna Papiez ◽

Małgorzata Bach ◽

...

Keyword(s):

Pilot Study ◽

Body Temperature ◽

Respiratory Tract ◽

Older Patients ◽

Respiratory Tract Infections ◽

Early Stage ◽

Patient Groups ◽

Project Data ◽

Tract Infections ◽

Infection Stage

AbstractIn the DECODE project, data were collected from 3,114 surveys filled by symptomatic patients RT-qPCR tested for SARS-CoV-2 in a single university centre in March-September 2020. The population demonstrated balanced sex and age with 759 SARS-CoV-2( +) patients. The most discriminative symptoms in SARS-CoV-2( +) patients at early infection stage were loss of taste/smell (OR = 3.33, p < 0.0001), body temperature above 38℃ (OR = 1.67, p < 0.0001), muscle aches (OR = 1.30, p = 0.0242), headache (OR = 1.27, p = 0.0405), cough (OR = 1.26, p = 0.0477). Dyspnea was more often reported among SARS-CoV-2(-) (OR = 0.55, p < 0.0001). Cough and dyspnea were 3.5 times more frequent among SARS-CoV-2(-) (OR = 0.28, p < 0.0001). Co-occurrence of cough, muscle aches, headache, loss of taste/smell (OR = 4.72, p = 0.0015) appeared significant, although co-occurrence of two symptoms only, cough and loss of smell or taste, means OR = 2.49 (p < 0.0001). Temperature > 38℃ with cough was most frequent in men (20%), while loss of taste/smell with cough in women (17%). For younger people, taste/smell impairment is sufficient to characterise infection, whereas in older patients co-occurrence of fever and cough is necessary. The presented study objectifies the single symptoms and interactions significance in COVID-19 diagnoses and demonstrates diverse symptomatology in patient groups.

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Dysphagia Prevalence, Time Course, and Association with Probable Sarcopenia, Inactivity, Malnutrition, and Disease Status in Older Patients Admitted to an Emergency Department: A Secondary Analysis of Cohort Study Data

Geriatrics ◽

10.3390/geriatrics6020046 ◽

2021 ◽

Vol 6 (2) ◽

pp. 46

Author(s):

Tina Hansen ◽

Rikke Lundsgaard Nielsen ◽

Morten Baltzer Houlind ◽

Juliette Tavenier ◽

Line Jee Hartmann Rasmussen ◽

...

Keyword(s):

Health Care ◽

Emergency Department ◽

Cohort Study ◽

Systemic Inflammation ◽

Older Patients ◽

Time Course ◽

Assessment Tool ◽

Handgrip Strength ◽

Secondary Analysis ◽

Disease Status

There is evolving evidence for an association between dysphagia and sarcopenia in older adults. For optimizing the acute health care initiative across health care settings, this study investigated prevalence and time-course of dysphagia in older patients admitted to an emergency department (ED) as well as its association with parameters for probable sarcopenia, inactivity, malnutrition, disease status, and systemic inflammation. A secondary analysis of data from the FAM-CPH cohort study on acutely admitted older medical patients (n = 125). Data were collected upon ED admission as well as four and 56 weeks after discharge. Using the Eating Assessment Tool cut-off score ≥ 2, signs of dysphagia were present in 34% of the patients at ED admission and persisted in 25% of the patients 56 weeks after discharge. Signs of dysphagia at 56-week follow-up were significantly (p < 0.05) associated with probable sarcopenia (low handgrip strength (OR = 3.79), low leg muscle strength (OR = 8.14), and low physical performance (OR = 5.68)) and with baseline swallowing inactivity (OR = 5.61), malnutrition (OR = 4.35), and systemic inflammation (OR = 1.33). Signs of dysphagia in older patients admitted to an ED was prevalent, persisted 56 weeks after discharge, and was associated with probable sarcopenia and related conditions; all modifiable targets for management of dysphagia in older patients.

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