Grant: Travel Awards - Institute Community Support

Introduction: Physicians are not adept at recognizing impaired mental status in elderly Emergency Department (ED) patients, a common and serious entity associated with increased morbidity and mortality. The Ottawa 3DY Scale (O3DY) is a 4 question screening tool that has been previously validated in this population. Our overall objective was to improve screening for impaired mental status in elderly ED patients. We assessed 1) level of implementation of the O3DY Scale; 2) prevalence of impaired mental status; 3) classification performance compared with the Mini Mental State Exam (MMSE); and 4) agreement between physician and nurse scores. Methods: We conducted a prospective cohort study enrolling patients > 74 years presenting to our ED. Patients underwent screening with the O3DY Scale by the bedside nurse and physician. Abnormalities resulted in a comprehensive cognitive evaluation. Descriptive statistics were used to assess level of implementation, prevalence of impaired mental status and sensitivity and specificity compared with the MMSE, using a cutoff of <25. Kappa coefficient was calculated. Results: 198 patients, 62.9% female with a mean age of 84.2, presented during study hours. Overall, 31.3% of patients had evidence of impaired mental status. Nurses and physicians screened 64.4% and 53.7% of patients, respectively. O3DY by nurses had a sensitivity of 90.1% (CI 57.1-99.5%) and specificity of 60% (32.9-82.5%). O3DY by physicians had a sensitivity of 72.7% (39.3-92.7%) and specificity of 50% (32.9-82.5%). The weighted kappa for agreement between nurse and physician O3DY Scale Scores was 0.79 (0.65, 0.94). Conclusions: The O3DY Scale is a feasible cognitive screening tool for elderly ED patients which demonstrated good sensitivity and specificity, particularly when implemented by nurses. Increased identification of cognitive impairment in elderly ED patients will lead to improved care and outcomes in this vulnerable patient population.