“Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database
Purpose: The Emergency Room Evaluation and Recommendation (ER2) is an application in the electronic medical file of patients visiting the Emergency Department (ED) of the Jewish General Hospital (JGH; Montreal, Quebec, Canada). It screens for older ED visitors at high risk of undesirable events. The...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-01-01
|
| Series: | Frontiers in Neurology |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2021.767285/full |
| _version_ | 1819283596692684800 |
|---|---|
| author | Olivier Beauchet Olivier Beauchet Olivier Beauchet Olivier Beauchet Liam A. Cooper-Brown Joshua Lubov Gilles Allali Gilles Allali Marc Afilalo Cyrille P. Launay |
| author_facet | Olivier Beauchet Olivier Beauchet Olivier Beauchet Olivier Beauchet Liam A. Cooper-Brown Joshua Lubov Gilles Allali Gilles Allali Marc Afilalo Cyrille P. Launay |
| author_sort | Olivier Beauchet |
| collection | DOAJ |
| description | Purpose: The Emergency Room Evaluation and Recommendation (ER2) is an application in the electronic medical file of patients visiting the Emergency Department (ED) of the Jewish General Hospital (JGH; Montreal, Quebec, Canada). It screens for older ED visitors at high risk of undesirable events. The aim of this study is to examine the performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [LR+], negative likelihood ratio [LR-] and area under the receiver operating characteristic curve [AUROC]) of the ER2 high-risk level and its “temporal disorientation” item alone to screen for major neurocognitive disorders in older ED visitors at the JGH.Methods: Based on a cross-sectional design, 999 older adults (age 84.9 ± 5.6, 65.1% female) visiting the ED of the JGH were selected from the ER2 database. ER2 was completed upon the patients' arrival at the ED. The outcomes were ER2's high-risk level, the answer to ER2's temporal disorientation item (present vs. absent), and the diagnosis of major neurocognitive disorders (yes vs. no) which was confirmed when it was present in a letter or other files signed by a physician.Results: The sensitivities of both ER2's high-risk level and temporal disorientation item were high (≥0.91). Specificity, the PPV, LR+, and AROC were higher for the temporal disorientation item compared to ER2's high-risk level, whereas a highest sensitivity, LR-, and NPV were obtained with the ER2 high-risk level. Both area under the receiver operating characteristic curves were high (0.71 for ER2's high-risk level and 0.82 for ER2 temporal disorientation item). The odds ratios (OR) of ER2's high-risk level and of temporal disorientation item for the diagnosis of major neurocognitive disorders were positive and significant with all OR above 18, the highest OR being reported for the temporal disorientation item in the unadjusted model [OR = 26.4 with 95% confidence interval (CI) = 17.7–39.3].Conclusion: Our results suggest that ER2 and especially its temporal disorientation item may be used to screen for major neurocognitive disorders in older ED users. |
| first_indexed | 2024-12-24T01:34:00Z |
| format | Article |
| id | doaj.art-77999db6ad524710902d7bfea60b60ba |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-12-24T01:34:00Z |
| publishDate | 2022-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-77999db6ad524710902d7bfea60b60ba2022-12-21T17:22:15ZengFrontiers Media S.A.Frontiers in Neurology1664-22952022-01-011210.3389/fneur.2021.767285767285“Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 DatabaseOlivier Beauchet0Olivier Beauchet1Olivier Beauchet2Olivier Beauchet3Liam A. Cooper-Brown4Joshua Lubov5Gilles Allali6Gilles Allali7Marc Afilalo8Cyrille P. Launay9Department of Medicine, University of Montreal, Montreal, QC, CanadaResearch Center of the Geriatric University Institute of Montreal, Montreal, QC, CanadaDivision of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, CanadaLee Kong Chian School of Medicine, Nanyang Technological University, Singapore, SingaporeFaculty of Medicine, McGill University, Montreal, QC, CanadaDivision of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, CanadaDivision of Neurology, Department of Neurosciences, Geneva University Hospitals, Geneva, SwitzerlandLeenaards Memory Center, Lausanne University Hospital, University of Lausanne, Lausanne, SwitzerlandEmergency Department, Jewish General Hospital, McGill University, Montreal, QC, CanadaDivision of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, Montreal, QC, CanadaPurpose: The Emergency Room Evaluation and Recommendation (ER2) is an application in the electronic medical file of patients visiting the Emergency Department (ED) of the Jewish General Hospital (JGH; Montreal, Quebec, Canada). It screens for older ED visitors at high risk of undesirable events. The aim of this study is to examine the performance criteria (i.e., sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], positive likelihood ratio [LR+], negative likelihood ratio [LR-] and area under the receiver operating characteristic curve [AUROC]) of the ER2 high-risk level and its “temporal disorientation” item alone to screen for major neurocognitive disorders in older ED visitors at the JGH.Methods: Based on a cross-sectional design, 999 older adults (age 84.9 ± 5.6, 65.1% female) visiting the ED of the JGH were selected from the ER2 database. ER2 was completed upon the patients' arrival at the ED. The outcomes were ER2's high-risk level, the answer to ER2's temporal disorientation item (present vs. absent), and the diagnosis of major neurocognitive disorders (yes vs. no) which was confirmed when it was present in a letter or other files signed by a physician.Results: The sensitivities of both ER2's high-risk level and temporal disorientation item were high (≥0.91). Specificity, the PPV, LR+, and AROC were higher for the temporal disorientation item compared to ER2's high-risk level, whereas a highest sensitivity, LR-, and NPV were obtained with the ER2 high-risk level. Both area under the receiver operating characteristic curves were high (0.71 for ER2's high-risk level and 0.82 for ER2 temporal disorientation item). The odds ratios (OR) of ER2's high-risk level and of temporal disorientation item for the diagnosis of major neurocognitive disorders were positive and significant with all OR above 18, the highest OR being reported for the temporal disorientation item in the unadjusted model [OR = 26.4 with 95% confidence interval (CI) = 17.7–39.3].Conclusion: Our results suggest that ER2 and especially its temporal disorientation item may be used to screen for major neurocognitive disorders in older ED users.https://www.frontiersin.org/articles/10.3389/fneur.2021.767285/fullemergency departmentmajor neurocognitive disordersscreeningolder adultsperformance evaluation |
| spellingShingle | Olivier Beauchet Olivier Beauchet Olivier Beauchet Olivier Beauchet Liam A. Cooper-Brown Joshua Lubov Gilles Allali Gilles Allali Marc Afilalo Cyrille P. Launay “Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database Frontiers in Neurology emergency department major neurocognitive disorders screening older adults performance evaluation |
| title | “Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database |
| title_full | “Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database |
| title_fullStr | “Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database |
| title_full_unstemmed | “Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database |
| title_short | “Emergency Room Evaluation and Recommendations” (ER2) Tool for the Screening of Older Emergency Department Visitors With Major Neurocognitive Disorders: Results From the ER2 Database |
| title_sort | emergency room evaluation and recommendations er2 tool for the screening of older emergency department visitors with major neurocognitive disorders results from the er2 database |
| topic | emergency department major neurocognitive disorders screening older adults performance evaluation |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2021.767285/full |
| work_keys_str_mv | AT olivierbeauchet emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT olivierbeauchet emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT olivierbeauchet emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT olivierbeauchet emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT liamacooperbrown emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT joshualubov emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT gillesallali emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT gillesallali emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT marcafilalo emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database AT cyrilleplaunay emergencyroomevaluationandrecommendationser2toolforthescreeningofolderemergencydepartmentvisitorswithmajorneurocognitivedisordersresultsfromtheer2database |