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The following is a summary of “Validating the fluctuating mental status evaluation in neurocritically ill patients with acute stroke,” published in the October 2024 issue of Critical Care by Reznik et al. 

Patients with neurocritical illness are at high risk for developing delirium, but existing delirium assessment tools are unreliable in this population due to neurologic deficits that interfere with conventional testing.  

Researchers conducted a retrospective study to investigate the accuracy and predictive validity of the Fluctuating Mental Status Evaluation (FMSE), a novel delirium screening tool designed for neurocritical illness.   

They examined 139 patients who were neurocritically ill (mean age, 63.9 [SD, 15.9].  Expert raters led daily Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-based delirium assessments, while paired FMSE assessments were conducted by trained clinicians, 717 total noncomatose days of paired assessments were assessed, from 52% (n=373) were rated by experts as days with delirium while 53% were delirious for one or more days.  

The results showed the overall accuracy of the FMSE was increased (area under the curve [AUC], 0.85; 95% CI, 0.82–0.87) compared with expert ratings, FMSE scores were higher than or equal to 1 had 86% sensitivity and 74% specificity on a per-assessment basis, while scores greater than or equal to 2 had 70% sensitivity and 88% specificity. Accuracy remained elevated in patients with aphasia (FMSE ≥ 1: 82% sensitivity, 64% specificity; FMSE ≥ 2: 64% sensitivity, 84% specificity) and those with decreased arousal (FMSE ≥ 1: 87% sensitivity, 71% sensitivity, 90% specificity). Positive FMSE assessments also had incredible accuracy when predicting functional outcomes at discharge (AUC, 0.86 [95% CI, 0.79–0.93]) and 3 months (AUC, 0.85 [95% CI, 0.78–0.92]).  

They concluded that FMSE was an accurate delirium screening tool in patients with neurocritical illness, with scores greater than or equal to 1 indicating “possible” delirium and scores greater than or equal to 2 denoting “probable” delirium. 

Source: journals.lww.com/ccmjournal/abstract/9900/validating_the_fluctuating_mental_status.385.aspx