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Journal of Neurology and Neurorehabilitation Research | Volume 4
November 04-05, 2019 | Melbourne, Australia
Neurology and Neurological Disorders
19
th
International Conference on
J Neurol Neurorehabil Res, Volume 4
Comparison of brief clinical delirium and cognitive testing amongst patients admitted
via the Trauma and Orthopaedic (T&O) acute intake - A service evaluation on the
clinical dependence, efficacy and accessibility of implementing Gwent Orientation
and Awareness Listing (GOAL) testing in relation to the 4AT at the Royal Gwent
Hospital Newport, UK
Jack Wellington LGMS
Cardiff University School of Medicine, UK
Background:
GOAL is the brief delirium/cognitive clinical test
currently employed at Royal Gwent Hospital Newport where
the 4AT test is routinely utilized. To our knowledge, both tests
have not been prospectively compared against, relative to
equal patient cohorts.
Objectives:
We aim to, (1) evaluate two rapidly performed
valid cognitive examinations amongst the same patient
cohort, and (2) assess patient testing results among acute/
emergency T&O admissions compared with previously
obtained patient data presenting via the acutemedical intake.
Methods:
Verbal consent to cognitive testing by means of
GOAL and 4AT was sought from patients presenting acutely
to T&O over four weeks period. A GOAL score of <8/10 is
deemed a “fail”, and on 4AT any error is deemed “possible
cognitive impairment”. Patient documentation regarding
dementia, epilepsy, psychiatric/neurological illness was
recorded alongside living arrangements.
Results:
There were 146 patients, of whom 10 were not well
enough to be scored, and 1 patient declined to participate.
Therefore, results are based on a 135-patient cohort, all of
whom were able to co-operate with both scores. Of these,
92 “passed” both tests, 40 “failed” on 4AT, of which 18 also
“failed” on GOAL. There were 3 who “failed” on GOAL but
passed on 4AT. Likelihood of test failure was significantly
greater with 4AT (Х2 =7.65, p<0.01). Ages and comparisons
on GOAL testing results with historical general medical
patient cohort displayed significant differences between
patient co-operation in acute medical and T&O intakes.
Conclusions:
(1) The 4AT test is more likely to signal cognitive
impairment than GOAL among T&O emergency admissions;
(2) T&O intake patients are more likely to co-operate with
cognitive testing by GOAL, and they perform better than
acute medical emergency admissions.
Speaker Biography
Jack Wellington LGMS is a year 4 Medical Student at Cardiff University
Medical School, eager to pursue a career in Neurosurgery alongside
attaining a DTM&H for clinical practice globally, achieve a PhD in Surgical
Sciences (specializing in Neuro infectious Diseases), a WHO Internship
in Geneva, and an academic foundation post (conducting research in
neurosurgical practice). I am currently intercalating at the LSHTM for
an MSc Medical Microbiology and aspire to undertake a neurosurgery
elective at Oxford/Harvard/Yale University. He currently holds various
national and university society positions, examples including Research and
Audit Lead for the Student Psychiatry Audit and Research Collaborative
(SPARC) UK, President and Founder of Cardiff University Infectious
Diseases Society, RCPSG Trainees’ Committee Undergraduate/Student
Member, previous positions including president, clinical and intensive
care leads for Cardiff University Dermatology, Clinical Neurosciences
and Anesthetics, Perioperative and Intensive Care Societies respectively,
and has lead several local and national audits/research projects.
e:
wellingtonj1@cardiff.ac.uk