Christopher R. Carpenter|Jay Banerjee|Daniel C. Keyes|Debra Eagles|Linda Schnitker|David Barbic|Susan A. Fowler|Michael A. LaMantia
Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta?analysis
Washington University in St. Louis|University Hospitals of Leicester NHS Trust|University of Leicester|Mercy Medical Center|Mercy Hospital|Michigan State University|St. Mary Mercy Livonia|University of Ottawa|Queensland University of Technology|University of British Columbia|Washington University in St. Louis|University of Vermont
dementia underrecognized older adult emergency department ed patients threatens operational efficiency diagnostic accuracy patient satisfaction society academic emergency medicine geriatric ed guidelines advocate dementia screening using validated instrumentsthe objective perform systematic review metaanalysis diagnostic accuracy sufficiently brief screening instruments dementia geriatric ed patients secondary objective define evidencebased pretest probability dementia based published research estimate disease thresholds dementia screening appropriate systematic review registered prospero crd42017074855pubmed embase cinahl central dare scopus searched studies ed patients ages 65 years older dementia included sufficient details reconstruct 2 2 tables reported quadas2 used assess study quality metaanalysis reported one study evaluated instrument reference standard outcomes sensitivity specificity positive negative likelihood ratios lr lr identify test treatment thresholds employed paukerkassirer methoda total 1616 publications identified 16 underwent full textreview nine studies included weighted average dementia prevalence 31 range 1243 eight studies used mini mental status examination mmse reference standard study used mmse conjunction geriatricians neurocognitive evaluation blinding index test andor reference standard inadequate four studies eight instruments evaluated 2423 patients across four countries europe north america abbreviated mental test amt4 accurately ruled dementia lr 769 95 confidence interval ci 3451710 brief alzheimers screen accurately ruled dementia lr 010 95 ci 002028 using estimates diagnostic accuracy amt4 metaanalysis one trigger comprehensive geriatric vulnerability assessments ed dementia screening benefits patients prescreening probability dementia 14 36edbased diagnostic research dementia screening limited studies using inadequate criterion standard variable masking interpreters access index test criterion standard standardizing geriatric ed cognitive assessment methods measures nomenclature necessary reduce uncertainties diagnostic accuracy reliability relevance acute care setting amt4 currently accurate ed screening instrument increase probability dementia brief alzheimers screen accurate decrease probability dementia dementia screening one marker vulnerability initiate comprehensive geriatric assessment warranted based testtreatment threshold calculations