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Screening instruments for cognitive impairment in older patients in the Emergency Department: a systematic review and meta-analysis
- Source :
- Age and Ageing
- Publication Year :
- 2020
- Publisher :
- Oxford University Press, 2020.
-
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).
- Subjects :
- Aging
medicine.medical_specialty
Adverse outcomes
older people
03 medical and health sciences
AcademicSubjects/MED00280
0302 clinical medicine
delirium
Older patients
medicine
Dementia
Humans
Mass Screening
Cognitive Dysfunction
030212 general & internal medicine
Cognitive impairment
Geriatric Assessment
cognitive impairment
Aged
business.industry
screening
030208 emergency & critical care medicine
General Medicine
Emergency department
Emergency Department
medicine.disease
Meta-analysis
Emergency medicine
Delirium
Systematic Review
Geriatrics and Gerontology
medicine.symptom
business
Older people
Emergency Service, Hospital
dementia
Subjects
Details
- Language :
- English
- ISSN :
- 14682834 and 00020729
- Volume :
- 50
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Age and Ageing
- Accession number :
- edsair.doi.dedup.....53e38ab94066db0ef0d3f56a2a5c47b9