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

Area of Science:

• Neuroscience
• Critical Care Medicine
• Psychiatry

Background:

• Neurocritically ill patients face a high risk of delirium, negatively impacting long-term outcomes.
• Existing delirium assessment tools are often unreliable in this population due to neurological deficits.

Purpose of the Study:

• To evaluate the accuracy and predictive validity of the Fluctuating Mental Status Evaluation (FMSE), a new screening tool for delirium.
• The FMSE was specifically designed for neurocritically ill patients with neurological impairments.

Main Methods:

• A prospective validation study was conducted in an academic medical center's neurocritical care unit.
• 139 neurocritically ill stroke patients were assessed.
• 717 noncomatose days of paired assessments (expert delirium diagnosis vs. FMSE) were analyzed.

Main Results:

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

Conclusions:

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