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The Mini-Mental State Examination as a diagnostic and screening test for delirium: systematic review and meta-analysis

The Mini-Mental State Examination as a diagnostic and screening test for delirium: systematic review and meta-analysis

Mitchell, Alex J., Shukla, Deepak, Ajumal, Hafsa A., Stubbs, Brendon and Tahir, Tayyeb A. (2014) The Mini-Mental State Examination 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:https://doi.org/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 March 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=50.9–83.5%) in studies using a predefined cutoff 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
Uncontrolled Keywords: delirium, mini-mental state, confusion, screening, older adults
Subjects: B Philosophy. Psychology. Religion > BF Psychology
Faculty / Department / Research Group: Faculty of Education & Health
Related URLs:
Last Modified: 14 Oct 2016 09:31
Selected for GREAT 2016: None
Selected for GREAT 2017: None
Selected for GREAT 2018: None
Selected for GREAT 2019: None
URI: http://gala.gre.ac.uk/id/eprint/13075

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