Evidence map›Paper›PMID 39365697›Full record

ArticleCritical care medicine2024

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

Michael E Reznik, Seth A Margolis, Nicholas Andrews, Colin Basso, Noa Mintz, Sean Varga, Beth E Snitz, Timothy D Girard, Lori A Shutter, E Wesley Ely and 1 more

Abstract readValidation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Prevention and Treatment of ICU Delirium in Brain Injured Patients.Current neurology and neuroscience reports · 2026
    Review
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Michael E ReznikCenter for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA), University of Pittsburgh School of Medicine, Pittsburgh, PA.ORCID 0000-0002-9251-5049
Seth A MargolisDepartment of Psychiatry and Human Behavior, Brown University, Alpert Medical School, Providence, RI.
Nicholas AndrewsDepartment of Neurology, Brown University, Alpert Medical School, Providence, RI.
Colin BassoDepartment of Neurology, Brown University, Alpert Medical School, Providence, RI.
Noa MintzDepartment of Neurology, Brown University, Alpert Medical School, Providence, RI.
Sean VargaDepartment of Neurology, Brown University, Alpert Medical School, Providence, RI.
Beth E SnitzDepartment of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Timothy D GirardCenter for Research, Investigation, and Systems Modeling of Acute Illness (CRISMA), University of Pittsburgh School of Medicine, Pittsburgh, PA.
Lori A ShutterDepartment of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
E Wesley ElyCritical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Richard N JonesDepartment of Psychiatry and Human Behavior, Brown University, Alpert Medical School, Providence, RI.

Funding

Supplement to Network for Investigation of Delirium across the U.S (NIDUS)R24AG054259 · NIA · HEBREW REHABILITATION CENTER FOR AGED · PI INOUYE, SHARON K. · 2016 to 2020
$4.3M
NIA NIH HHS R24 AG054259
6 · The paper itself

Abstract

objectivesNeurocritically ill patients are at high risk for developing delirium, which can worsen the long-term outcomes of this vulnerable population. However, existing delirium assessment tools do not account for neurologic deficits that often interfere with conventional testing and are therefore unreliable in neurocritically ill patients. We aimed to determine the accuracy and predictive validity of the Fluctuating Mental Status Evaluation (FMSE), a novel delirium screening tool developed specifically for neurocritically ill patients.

designProspective validation study.

settingNeurocritical care unit at an academic medical center. PATIENTS: One hundred thirty-nine neurocritically ill stroke patients (mean age, 63.9 [ sd , 15.9], median National Institutes of Health Stroke Scale score 11 [interquartile range, 2-17]).

interventionsNone. MEASUREMENTS AND MAIN

resultsExpert raters performed daily Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-based delirium assessments, while paired FMSE assessments were performed by trained clinicians. We analyzed 717 total noncomatose days of paired assessments, of which 52% ( n = 373) were rated by experts as days with delirium; 53% of subjects were delirious during one or more days. Compared with expert ratings, the overall accuracy of the FMSE was high (area under the curve [AUC], 0.85; 95% CI, 0.82-0.87). FMSE scores greater 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 high 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, 77% specificity; FMSE ≥ 2: 71% sensitivity, 90% specificity). Positive FMSE assessments also had excellent 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]).

conclusionsIn this validation study, we found that the FMSE was an accurate delirium screening tool in neurocritically ill stroke patients. FMSE scores greater than or equal to 1 indicate "possible" delirium and should be used when prioritizing sensitivity, whereas scores greater than or equal to 2 indicate "probable" delirium and should be used when prioritizing specificity.

Indexed as

Critical IllnessDeliriumStrokeAgedAged, 80 and overFemaleHumansIntensive Care UnitsMaleMental Status and Dementia TestsMiddle AgedProspective StudiesReproducibility of ResultsSensitivity and Specificity

Identifiers

PMID39365697
PMCPMC12490652

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.