Validating the Fluctuating Mental Status Evaluation in Neurocritically Ill Patients With Acute Stroke

Area of Science:

• Neuroscience
• Critical Care Medicine
• Psychiatry

Background:

• Delirium is common and detrimental in neurocritically ill patients.
• Existing delirium assessment tools are unreliable in this population due to neurological deficits.

Purpose of the Study:

• To determine the accuracy and predictive validity of the novel Fluctuating Mental Status Evaluation (FMSE) tool.
• To assess the FMSE's utility in neurocritically ill patients, specifically stroke patients.

Main Methods:

• Prospective validation study conducted in an academic medical center's neurocritical care unit.
• 139 neurocritically ill stroke patients were included.
• Paired assessments using the FMSE and expert delirium ratings (DSM-5 criteria) were performed on 717 noncomatose days.

Main Results:

• The FMSE demonstrated high overall accuracy (AUC, 0.85) compared to expert ratings.
• FMSE scores ≥ 1 showed 86% sensitivity and 74% specificity; scores ≥ 2 showed 70% sensitivity and 88% specificity.
• The FMSE maintained high accuracy in patients with aphasia and decreased arousal, and accurately predicted functional outcomes at discharge and 3 months.

Conclusions:

• The FMSE is an accurate delirium screening tool for neurocritically ill stroke patients.
• FMSE scores ≥ 1 suggest "possible" delirium (prioritizing sensitivity).
• FMSE scores ≥ 2 suggest "probable" delirium (prioritizing specificity).