Knowledge, skills and attitudes of doctors towards assessing cognition in older patients in the emergency department

Kennelly, Sean; Morley, Deirdre; Coughlan, Tara; Collins, Rónán; Rochford, Martin; O’Neill, Desmond

doi:10.1136/postgradmedj-2012-131226

Cited by 41 publications

(46 citation statements)

References 20 publications

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“…Dalam beberapa penelitian, pasien usia lanjut datang ke IGD dengan presentasi klinis yang atipikal dan belum tentu disertai dengan perubahan tanda vital. 9,10 Oleh karena itu, validasi skor REMS untuk populasi khusus ini penting dilakukan. …”

Section: Pendahuluanunclassified

Performa Rapid Emergency Medicine Score (REMS) dalam Memprediksi Mortalitas 30 Hari Pasien Usia Lanjut di Instalasi Gawat Darurat

Rizka¹,

Harimurti²,

Pitoyo³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Rapid Emergency Medicine Score (REMS) merupakan suatu instrumen yang banyak digunakan untuk melakukan stratifikasi risiko pasien non-bedah di Instalasi Gawat Darurat (IGD). Namun, pasien usia lanjut yang datang ke IGD seringkali datang dengan manifestasi klinis yang atipikal, sehingga performa REMS untuk populasi khusus ini perlu diuji. Penelitian ini dilakukan untuk menilai performa REMS pada populasi pasien usia lanjut yang datang ke IGD.Metode. Dilakukan penelitian kohort prospektif berbasis penelitian prognostik pada pasien usia >60 tahun yang datang ke IGD RS dr. Cipto Mangunkusumo (RSCM), Jakarta selama September hingga Oktober 2016. Subjek diikuti selama 30 hari sejak kedatangan ke IGD. Selanjutnya dilakukan perhitungan kalibrasi (uji Hosmer Lemeshow) dan diskriminasi (perhitungan Area under ROC Curve) REMS dalam memprediksi mortalitas 30 hari pasien usia lanjut.Hasil. Terdapat 321 pasien usia lanjut masuk IGD selama periode penelitian dan 306 di antaranya memenuhi kriteria pemilihan. Dari seluruh subjek, 163 (53,2% pasien adalah laki-laki. Insiden kematian 30 hari sebanyak 22,8% (IK95% 22,3-23,3). Rerata usia 68,3 (SB 6,7) tahun. Sebanyak 83 (27%) pasien dikategorikan triage merah. Terdapat 154 (50%) pasien dengan REMS 0-7, 140 (46%) dengan REMS 8-17 dan 12(4%) with REMS lebih dari 17. Plot kalibrasi menunjukkan r=0,23 dengan hasil uji Hosmer Lemeshow buruk (p=0,00). AUC REMS untuk memprediksi mortalitas 30 hari pasien usia lanjut adalah 0,45 (95% CI 0,23-0,66).Simpulan. REMS menunjukkan performa yang buruk dalam memprediksi mortalitas 30 hari pasien usia lanjut di IGD.

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Section: Pendahuluanunclassified

Performa Rapid Emergency Medicine Score (REMS) dalam Memprediksi Mortalitas 30 Hari Pasien Usia Lanjut di Instalasi Gawat Darurat

Rizka¹,

Harimurti²,

Pitoyo³

et al. 2017

JPDI

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“…Assessment rates for cognitive impairment and recording of such are typically low in the ED environment 8 18. While most physicians feel that screening cognition in the ED is important, many feel that time constraints, the physical infrastructure of the ED and concerns over privacy and noise deem the ED environment unsuitable for assessing cognition 18.…”

Section: Introductionmentioning

confidence: 99%

“…While most physicians feel that screening cognition in the ED is important, many feel that time constraints, the physical infrastructure of the ED and concerns over privacy and noise deem the ED environment unsuitable for assessing cognition 18. In one report, only 28% of patients with impaired cognitive function had this documented, 70% of whom had no prior history of dementia 8.…”

Section: Introductionmentioning

confidence: 99%

Cognitive assessment of older adults at the acute care interface: the informant history

Dyer

Nabeel

Briggs

et al. 2016

Postgraduate Medical Journal

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The informant history represents a much underused tool in the cognitive assessment of older adults presenting to the ED. The main barrier to informant interviewing in the ED environment appears to be informant availability. Where available, the informant history is easy to extract and provides invaluable information to the assessing physician. The acute care environment is suitable to brief informant interviews using readily available frameworks (AD8). However, the informant history is rarely obtained in this context, and further emphasis on undergraduate and postgraduate medical curricula is warranted.

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“…Cognitive examination skills too may not be well taught. In a study of emergency settings, a majority of emergency physicians identified cognitive screening as important but a third believed they lacked the expertise to conduct a cognitive screen (Kennelly et al, 2013).…”

Section: Psychiatry and Deliriummentioning

confidence: 99%

The role of diagnosis in delirium

Bhat

Rockwood

2016

Int. Psychogeriatr.

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Delirium is common and is commonly misdiagnosed, chiefly in being missed (Bhat and Rockwood, 2007). The consequences of misdiagnosis are often severe and wide ranging, affecting patients, caregivers, health professionals, and hospitals (Inouye et al., 2014). Many an older hospitalized person with delirium is trapped in the interface between psychiatry and the rest of medicine, and can too easily be caught in the tendentious battles between treating teams. Both researchers and policymakers have sought to improve this unacceptable state of affairs (Young et al., 2010; Tieges et al., 2015).

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Knowledge, skills and attitudes of doctors towards assessing cognition in older patients in the emergency department

Cited by 41 publications

References 20 publications

Performa Rapid Emergency Medicine Score (REMS) dalam Memprediksi Mortalitas 30 Hari Pasien Usia Lanjut di Instalasi Gawat Darurat

Performa Rapid Emergency Medicine Score (REMS) dalam Memprediksi Mortalitas 30 Hari Pasien Usia Lanjut di Instalasi Gawat Darurat

Cognitive assessment of older adults at the acute care interface: the informant history

The role of diagnosis in delirium

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