A Pilot Study of the Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool for Neurocritical Care Patients.
Delirium
Intracerebral hemorrhage
Neurocritical care
Stroke
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
06
05
2022
accepted:
15
09
2022
medline:
13
4
2023
pubmed:
15
10
2022
entrez:
14
10
2022
Statut:
ppublish
Résumé
Delirium occurs frequently in patients with stroke and neurocritical illness but is often underrecognized. We developed a novel delirium screening tool designed specifically for neurocritical care patients called the fluctuating mental status evaluation (FMSE) and aimed to test its usability and accuracy in a representative cohort of patients with intracerebral hemorrhage (ICH). We performed a single-center prospective study in a pilot cohort of patients with ICH who had daily delirium assessments throughout their admission. Reference-standard expert ratings were performed each afternoon using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and were derived from bedside assessments and clinical data from the preceding 24 h. Paired FMSE assessments were performed by patients' clinical nurses after receiving brief one-on-one training from research staff. Nursing assessments were aggregated over 24-h periods (including day and night shifts), and accuracy of the FMSE was analyzed in patients who were not comatose to determine optimal scoring thresholds. We enrolled 40 patients with ICH (mean age 71.1 ± 12.2, 55% male, median National Institutes of Health Stroke Scale score 16.5 [interquartile range 12-20]), of whom 85% (n = 34) experienced delirium during their hospitalization. Of 308 total coma-free days with paired assessments, 208 (68%) were rated by experts as days with delirium. Compared with expert ratings, FMSE scores ≥ 1 had 86% sensitivity and 73% specificity on a per-day basis, whereas FMSE scores ≥ 2 had 68% sensitivity and 82% specificity. Accuracy remained high in patients with aphasia (FMSE scores ≥ 1: 83% sensitivity, 77% specificity; FMSE scores ≥ 2: 68% sensitivity, 85% specificity) and decreased arousal (FMSE scores ≥ 1: 80% sensitivity, 100% specificity; FMSE scores ≥ 2: 73% sensitivity, 100% specificity). In this pilot study, the FMSE achieved a high sensitivity and specificity in detecting delirium. Follow-up validation studies in a larger more diverse cohort of neurocritical care patients will use score cutoffs of ≥ 1 as "possible" delirium and ≥ 2 as "probable" delirium.
Sections du résumé
BACKGROUND
Delirium occurs frequently in patients with stroke and neurocritical illness but is often underrecognized. We developed a novel delirium screening tool designed specifically for neurocritical care patients called the fluctuating mental status evaluation (FMSE) and aimed to test its usability and accuracy in a representative cohort of patients with intracerebral hemorrhage (ICH).
METHODS
We performed a single-center prospective study in a pilot cohort of patients with ICH who had daily delirium assessments throughout their admission. Reference-standard expert ratings were performed each afternoon using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and were derived from bedside assessments and clinical data from the preceding 24 h. Paired FMSE assessments were performed by patients' clinical nurses after receiving brief one-on-one training from research staff. Nursing assessments were aggregated over 24-h periods (including day and night shifts), and accuracy of the FMSE was analyzed in patients who were not comatose to determine optimal scoring thresholds.
RESULTS
We enrolled 40 patients with ICH (mean age 71.1 ± 12.2, 55% male, median National Institutes of Health Stroke Scale score 16.5 [interquartile range 12-20]), of whom 85% (n = 34) experienced delirium during their hospitalization. Of 308 total coma-free days with paired assessments, 208 (68%) were rated by experts as days with delirium. Compared with expert ratings, FMSE scores ≥ 1 had 86% sensitivity and 73% specificity on a per-day basis, whereas FMSE scores ≥ 2 had 68% sensitivity and 82% specificity. Accuracy remained high in patients with aphasia (FMSE scores ≥ 1: 83% sensitivity, 77% specificity; FMSE scores ≥ 2: 68% sensitivity, 85% specificity) and decreased arousal (FMSE scores ≥ 1: 80% sensitivity, 100% specificity; FMSE scores ≥ 2: 73% sensitivity, 100% specificity).
CONCLUSIONS
In this pilot study, the FMSE achieved a high sensitivity and specificity in detecting delirium. Follow-up validation studies in a larger more diverse cohort of neurocritical care patients will use score cutoffs of ≥ 1 as "possible" delirium and ≥ 2 as "probable" delirium.
Identifiants
pubmed: 36241773
doi: 10.1007/s12028-022-01612-1
pii: 10.1007/s12028-022-01612-1
pmc: PMC10101875
mid: NIHMS1857056
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
388-394Subventions
Organisme : NIA NIH HHS
ID : R24 AG054259
Pays : United States
Organisme : NIA NIH HHS
ID : R33 AG071744
Pays : United States
Informations de copyright
© 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
Références
Am J Crit Care. 2014 Jan;23(1):60-9
pubmed: 24382618
Intensive Care Med. 2016 Jan;42(1):122-3
pubmed: 26170098
Stroke. 2022 Feb;53(2):505-513
pubmed: 34607468
Am J Respir Crit Care Med. 2011 Aug 1;184(3):340-4
pubmed: 21562131
J Neurol. 2012 Aug;259(8):1590-9
pubmed: 22234842
Neurology. 2020 Nov 17;95(20):e2727-e2735
pubmed: 32913011
J Biomed Inform. 2019 Jul;95:103208
pubmed: 31078660
Br J Psychiatry. 2007 Feb;190:135-41
pubmed: 17267930
Crit Care Med. 2020 Jan;48(1):111-118
pubmed: 31567406
Stroke. 2012 Mar;43(3):645-9
pubmed: 22267831
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
Crit Care Med. 2020 Jul;48(7):e636-e637
pubmed: 32568921
Am J Geriatr Psychiatry. 2013 Dec;21(12):1244-53
pubmed: 24080383
J Neurol Sci. 2018 Jul 15;390:102-107
pubmed: 29801867