@article{ref1,
title="Optimizing the month of the year backwards test for delirium screening of older patients in the emergency department",
journal="American journal of emergency medicine",
year="2019",
author="Hasemann, Wolfgang and Grossmann, Florian F. and Bingisser, Roland and Hafner, Martina and Breil, Dieter and Kressig, Reto W. and Nickel, Christian H.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
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. <br><br>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. <br><br>RESULTS: For the scoring method &quot;number of errors&quot;, 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 &quot;number of errors in combination with time needed&quot; resulted in a comparable result with minimally lower positive likelihood ratios. For the scoring method &quot;last month in correct order&quot;, 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. <br><br>DISCUSSION: We suggest omitting the factor time and using a more practical scoring method with good performance: &quot;last month in correct order&quot; with the requirement to reach September to rule out delirium.<br><br>Copyright © 2019 Elsevier Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0735-6757",
doi="10.1016/j.ajem.2019.06.035",
url="http://dx.doi.org/10.1016/j.ajem.2019.06.035"
}