Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Abstract:
BACKGROUND\nDementia is underrecognized in older adult emergency department (ED) patients, which threatens operational efficiency, diagnostic accuracy, and patient satisfaction. The Society for Academic Emergency Medicine geriatric ED guidelines advocate dementia screening using validated instruments.\n\n\nOBJECTIVES\nThe objective was to perform a systematic review and meta-analysis of the diagnostic accuracy of sufficiently brief screening instruments for dementia in geriatric ED patients. A secondary objective was to define an evidence-based pretest probability of dementia based on published research and then estimate disease thresholds at which dementia screening is most appropriate. This systematic review was registered with PROSPERO (CRD42017074855).\n\n\nMETHODS\nPubMed, EMBASE, CINAHL, CENTRAL, DARE, and SCOPUS were searched. Studies in which ED patients ages 65 years or older for dementia were included if sufficient details to reconstruct 2\xa0×\xa02 tables were reported. QUADAS-2 was used to assess study quality with meta-analysis reported if more than one study evaluated the same instrument against the same reference standard. Outcomes were sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-). To identify test and treatment thresholds, we employed the Pauker-Kassirer method.\n\n\nRESULTS\nA total of 1,616 publications were identified, of which 16 underwent full text-review; nine studies were included with a weighted average dementia prevalence of 31% (range, 12%-43%). Eight studies used the Mini Mental Status Examination (MMSE) as the reference standard and the other study used the MMSE in conjunction with a geriatrician s neurocognitive evaluation. Blinding to the index test and/or reference standard was inadequate in four studies. Eight instruments were evaluated in 2,423 patients across four countries in Europe and North America. The Abbreviated Mental Test (AMT-4) most accurately ruled in dementia (LR+\xa0= 7.69 [95% confidence interval {CI}\xa0= 3.45-17.10]) while the Brief Alzheimer s Screen most accurately ruled out dementia (LR-\xa0= 0.10 [95% CI\xa0= 0.02-0.28]). Using estimates of diagnostic accuracy for AMT-4 from this meta-analysis as one trigger for more comprehensive geriatric vulnerability assessments, ED dementia screening benefits patients when the prescreening probability of dementia is between 14 and 36%.\n\n\nCONCLUSIONS\nED-based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter s access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT-4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer s Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test-treatment threshold calculations.
Author Listing: Christopher R Carpenter;Jay Banerjee;Daniel Keyes;Debra Eagles;Linda Schnitker;David Barbic;Susan Fowler;Michael A LaMantia
Volume: 26
Pages: 226–245
DOI: 10.1111/acem.13573
Language: English
Journal: Academic Emergency Medicine

ACADEMIC EMERGENCY MEDICINE

ACAD EMERG MED

影响因子:3.4 是否综述期刊:否 是否OA:否 是否预警:不在预警名单内 发行时间:1994 ISSN:1069-6563 发刊频率:Monthly 收录数据库:SCIE/Scopus收录 出版国家/地区:UNITED STATES 出版社:Wiley-Blackwell

期刊介绍

Academic Emergency Medicine (AEM) is the official monthly publication of the Society for Academic Emergency Medicine (SAEM) and publishes information relevant to the practice, educational advancements, and investigation of emergency medicine. It is the second-largest peer-reviewed scientific journal in the specialty of emergency medicine.The goal of AEM is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to promote SAEM's goals and objectives. Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, as well as for clinical news, case studies and more.Each issue contains information relevant to the research, educational advancements, and practice in emergency medicine. Subject matter is diverse, including preclinical studies, clinical topics, health policy, and educational methods. The research of SAEM members contributes significantly to the scientific content and development of the journal.

学术急救医学(AEM)是学术急救医学学会(SAEM)的官方月刊,发布与急救医学实践、教育进步和研究相关的信息。它是急诊医学专业的第二大同行评审科学期刊。AEM的目标是促进急诊医学的科学、教育和临床实践,为急诊医学学术界发声,并促进SAEM的目标和目的。全世界的会员和非会员都依靠这本杂志来获得与急诊医学相关的转化医学,以及临床新闻,案例研究等。每期都包含与急诊医学的研究,教育进步和实践相关的信息。主题是多样化的,包括临床前研究、临床主题、卫生政策和教育方法。SAEM成员的研究对该杂志的科学内容和发展做出了重大贡献。

年发文量 114
国人发稿量 -
国人发文占比 0%
自引率 8.8%
平均录取率 较易
平均审稿周期 一般,3-8周
版面费 US$3600
偏重研究方向 医学-急救医学
期刊官网 http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1553-2712
投稿链接 http://mc.manuscriptcentral.com/aemj

质量指标占比

研究类文章占比 OA被引用占比 撤稿占比 出版后修正文章占比
80.53% 16.28% 0.00% 0.00%

相关指数

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期刊预警不是论文评价,更不是否定预警期刊发表的每项成果。《国际期刊预警名单(试行)》旨在提醒科研人员审慎选择成果发表平台、提示出版机构强化期刊质量管理。

预警期刊的识别采用定性与定量相结合的方法。通过专家咨询确立分析维度及评价指标,而后基于指标客观数据产生具体名单。

具体而言,就是通过综合评判期刊载文量、作者国际化程度、拒稿率、论文处理费(APC)、期刊超越指数、自引率、撤稿信息等,找出那些具备风险特征、具有潜在质量问题的学术期刊。最后,依据各刊数据差异,将预警级别分为高、中、低三档,风险指数依次减弱。

《国际期刊预警名单(试行)》确定原则是客观、审慎、开放。期刊分区表团队期待与科研界、学术出版机构一起,夯实科学精神,打造气正风清的学术诚信环境!真诚欢迎各界就预警名单的分析维度、使用方案、值得关切的期刊等提出建议!

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时间 预警情况
2024年02月发布的2024版 不在预警名单中
2023年01月发布的2023版 不在预警名单中
2021年12月发布的2021版 不在预警名单中
2020年12月发布的2020版 不在预警名单中

JCR分区 WOS分区等级:Q1区

版本 按学科 分区
WOS期刊SCI分区
WOS期刊SCI分区是指SCI官方(Web of Science)为每个学科内的期刊按照IF数值排 序,将期刊按照四等分的方法划分的Q1-Q4等级,Q1代表质量最高,即常说的1区期刊。
(2021-2022年最新版)
EMERGENCY MEDICINE Q1

关于2019年中科院分区升级版(试行)

分区表升级版(试行)旨在解决期刊学科体系划分与学科发展以及融合趋势的不相容问题。由于学科交叉在当代科研活动的趋势愈发显著,学科体系构建容易引发争议。为了打破学科体系给期刊评价带来的桎梏,“升级版方案”首先构建了论文层级的主题体系,然后分别计算每篇论文在所属主题的影响力,最后汇总各期刊每篇论文分值,得到“期刊超越指数”,作为分区依据。

分区表升级版(试行)的优势:一是论文层级的主题体系既能体现学科交叉特点,又可以精准揭示期刊载文的多学科性;二是采用“期刊超越指数”替代影响因子指标,解决了影响因子数学性质缺陷对评价结果的干扰。整体而言,分区表升级版(试行)突破了期刊评价中学科体系构建、评价指标选择等瓶颈问题,能够更为全面地揭示学术期刊的影响力,为科研评价“去四唯”提供解决思路。相关研究成果经过国际同行的认可,已经发表在科学计量学领域国际重要期刊。

《2019年中国科学院文献情报中心期刊分区表升级版(试行)》首次将社会科学引文数据库(SSCI)期刊纳入到分区评估中。升级版分区表(试行)设置了包括自然科学和社会科学在内的18个大类学科。基础版和升级版(试行)将过渡共存三年时间,推测在此期间各大高校和科研院所仍可能会以基础版为考核参考标准。 提示:中科院分区官方微信公众号“fenqubiao”仅提供基础版数据查询,暂无升级版数据,请注意区分。

中科院分区 查看说明

版本 大类学科 小类学科 Top期刊 综述期刊
医学
3区
EMERGENCY MEDICINE
急救医学
3区
2021年12月
基础版
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急救医学
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2021年12月
升级版
医学
3区
EMERGENCY MEDICINE
急救医学
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2020年12月
旧的升级版
医学
2区
EMERGENCY MEDICINE
急救医学
2区
2022年12月
最新升级版
医学
3区
EMERGENCY MEDICINE
急救医学
3区