Mitchell, Alex J., Shukla, Deepak, Ajumal, Hafsa A., Stubbs, Brendon and Tahir, Tayyeb A. (2014) The Mini-Mental State Examination (MMSE) as a diagnostic and screening test for delirium: Systematic review and meta-analysis. General Hospital Psychiatry, 36 (6). pp. 627-633. ISSN 0163-8343 (doi:10.1016/j.genhosppsych.2014.09.003)

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Abstract

Objective:
To analyse the evidence concerning the accuracy of the Mini-Mental State Examination (MMSE) as a diagnostic and screening test for the presence of delirium in adults.

Method:
Two authors searched MEDLINE, PsychINFO and EMBASE from inception till 3/2014. Articles were included that investigated the diagnostic validity of the MMSE to detect delirium against standardised criteria. A diagnostic validity meta-analysis was conducted.

Results:
Thirteen studies were included representing 2017 patients in medical settings of whom 29.4% had delirium. The meta-analysis revealed the MMSE had an overall sensitivity and specificity estimate of 84.1% and 73.0%, but this was 81.1% and 82.8% in a subgroup analysis involving robust high quality studies. Sensitivity was unchanged but specificity was 68.4% (95% CI = 50.9% to 83.5%) in studies using a predefined cut-off of < 24 to signify a case. In high-risk samples where delirium was present in 25% of patients, then the Positive predictive value and Negative predictive value would be 50.9% (48.3% - 66.2%) and 93.2% (90.0% - 96.5%).

Conclusion:
The MMSE cannot be recommended as a case-finding confirmatory test of delirium, but may be used as an initial screen to rule out high scorers who are unlikely to have delirium with approximately 93% accuracy.

Item Type:	Article
Additional Information:	This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Uncontrolled Keywords:	delirium, mini-mental state, confusion, screening, older adults
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Faculty / School / Research Centre / Research Group:	Faculty of Education, Health & Human Sciences
Last Modified:	14 Oct 2016 09:28
URI:	http://gala.gre.ac.uk/id/eprint/12118

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