Predictive value and interrater reliability of mental status and mobility assessment in the emergency department

Tanguy Espejo, Henk B. Riedel, Sebastian Messingschlager, Wolfram Sonnleitner, John Kellett, Mikkel Brabrand, Tim Cooksley, Roland Bingisser, Christian H. Nickel*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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Abstract

Aim: To investigate the predictive value of both mental status, assessed with the AVPUC (Alert, responds to Voice, responds to Pain, Unresponsive, and new Confusion) scale, and mobility assessments, and their interrater reliability (IRR) between triage clinicians and a research team. Method: Prospective study of consecutive patients who presented to an ED. Mental status and mobility were assessed by triage clinicians and by a dedicated research team. Results: 4,191 patients were included. After adjustment for age and sex, patients with altered mental status have an odds ratio of 6.55 [4.09–10.24] to be admitted in the ICU and an odds ratio of 21.16 [12.06–37.01] to die within 30 days; patients with impaired mobility have an odds ratio of 7.08 [4.60–11.12] to be admitted in the ICU and an odds ratio of 12.87 [5.93–32.30] to die within 30 days. The kappa coefficient between triage clinicians and the research team for mental status assessment was 0.75, and 0.80 for mobility. Conclusion: Assessment of mental status by the AVPUC scale, and mobility by a simple dichotomous scale are suitable for ED triage. Both altered mental status and impaired mobility are associated with adverse outcomes. Mental status and mobility assessment have good interrater reliability.

Original languageEnglish
Article number100027
JournalClinical Medicine, Journal of the Royal College of Physicians of London
Volume24
Issue number2
ISSN1470-2118
DOIs
Publication statusPublished - Mar 2024

Keywords

  • Acute medicine
  • AVPUC
  • AVPUC scale
  • Emergency department
  • Geriatric emergency medicine
  • Interrater reliability
  • Mental status
  • Mobility
  • Prognostication

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