Abstract
Introduction
Different scoring methods exist for the Month of the Year Backward Test (MBT), which
is designed to detect inattention, the core feature of delirium. When used as a part
of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED),
each error in the MBT scores one point. Because this scoring procedure is complex,
we aimed to simplify the scoring method of the MBT.
Methods
This is a secondary analysis of a single center prospective validation study of the
mCAM-ED comprising a sample of Emergency Department (ED) patients aged 65 or older
presenting to our ED.
Data collection
Research assistants (RAs) who were trained nurses conducted the MBT. Geriatricians
conducted the reference standard delirium assessment within 1 h of the RA.
Results
For the scoring method “number of errors”, optimal performance according the Youden
index was achieved when 8 or more errors were reached resulting in an overall sensitivity
of 0.95 and overall specificity of 0.94. The scoring method “number of errors in combination
with time needed” resulted in a comparable result with minimally lower positive likelihood
ratios. For the scoring method “last month in correct order”, optimal performance
according the Youden index was achieved with the month of September resulting in an
overall sensitivity of 0.90 and an overall specificity of 0.89.
Discussion
We suggest omitting the factor time and using a more practical scoring method with
good performance: “last month in correct order” with the requirement to reach September
to rule out delirium.
Keywords
Abbreviations:
mCAM-ED (modified Confusion Assessment Method for the Emergency Department), MBT (month of the year backwards test)To read this article in full you will need to make a payment
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of Emergency MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Incidence of delirium in the Canadian emergency department and its consequences on hospital length of stay: a prospective observational multicentre cohort study.BMJ Open. 2018; 8e018190https://doi.org/10.1136/bmjopen-2017-018190
- Delirium in the emergency department: an independent predictor of death within 6 months.Ann Emerg Med. 2010; 56: 244-52 e1https://doi.org/10.1016/j.annemergmed.2010.03.003
- Months backward test: a review of its use in clinical studies.World J Psychiatry. 2015; 5: 305-314https://doi.org/10.5498/wjp.v5.i3.305
- Does a year have 6 months or 12? Implications for delirium detection among hospitalized older general medicine patients.J Gen Intern Med. 2019; 34: 354-355https://doi.org/10.1007/s11606-018-4704-3
- Preliminary development of an ultrabrief two-item bedside test for delirium.J Hosp Med. 2015; 10: 645-650https://doi.org/10.1002/jhm.2418
- Reciting the months of the year backwards: what is a 'normal' score?.Age Ageing. 2015; 44: 537-538https://doi.org/10.1093/ageing/afv056
- Screening, detection and management of delirium in the emergency department – a pilot study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED).Scand J Trauma Resusc Emerg Med. 2014; 22: 19https://doi.org/10.1186/1757-7241-22-19
- Screening and detection of delirium in older ED patients: performance of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). A two-step tool.Intern Emerg Med. 2017; : 1-8https://doi.org/10.1007/s11739-017-1781-y
- The bedside confusion scale: development of a portable bedside test for confusion and its application to the palliative medicine population.J Palliat Med. 2000; 3: 449-456https://doi.org/10.1089/jpm.2000.3.4.449
- Delirium, dementia, and amnestic and other cognitive disorders. Diagnostic and statistical manual of mental disorders DSM-IV-TR.4th ed. American Psychiatric Association, Washington, DC2000: 135-147
- Improving the diagnostic accuracy of the mini-mental state examination.Acta Neurol Scand. 1995; 92: 145-150
- Approximate is better than “exact” for interval estimation of binomial proportions.Am Stat. 1998; 52: 119-126
- Statistical methods in diagnostic medicine.2nd ed. Wiley-Blackwell, Oxford2011
- Utility of the month of the year backwards test (MOTYB) in detecting delirium: analysis of error patterns and overall performance in 149 older hospitalised patients.in: Presented at the 11 Anual Meeting of the European Delirium Association. 2017 (Oslo, Norway)
- Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study.Age Ageing. 2016; 45: 832-837https://doi.org/10.1093/ageing/afw130
- Focusing on inattention: the diagnostic accuracy of brief measures of inattention for detecting delirium.J Hosp Med. 2018; https://doi.org/10.12788/jhm.2943
Article Info
Publication History
Published online: June 21, 2019
Accepted:
June 20,
2019
Received in revised form:
June 19,
2019
Received:
November 18,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
