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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
Objectives:
•
Primary Objectives:
Assess 2 rapidly-performed valid cognitive examinations, the GOAL
and 4AT, amongst T&O intake according to clinical effectiveness,
availability and reliability. Critically-appraise acute/emergency T&O
admissions testing results compared with the previous acute medical
intake patient dataset.
•
Secondary Objectives:
Evaluate appropriate patient past medical (and social) histories on
GOAL and 4AT testing alongside study participant demographics to
identifycertain factorswhichmay impact testing success/failure rates
for both cognitive testing systems.
Figure1 -Outlineofparticipantdata collected for4-week studyperiod.
Figure2 -ComparisonbetweenT&Oandgeneralmedical intakes for currentandhistoricaldatasets
(*Х
2
=8.51,p<0.01; SD -StandardDeviation).
COMPARISON OF BRIEF CLINICAL DELIRIUM AND COGNITIVE TESTING AMONGST PATIENTS ADMITTED VIA THE TRAUMA AND ORTHOPAEDIC
(T&O) ACUTE INTAKE:
A SERVICEEVALUATIONONTHECLINICALDEPENDENCE,EFFICACYANDACCESSIBILITYOF IMPLEMENTINGGWENTORIENTATIONANDAWARENESS LISTING
(GOAL)TESTING INRELATIONTO THE4ATATTHEROYALGWENTHOSPITALNEWPORT
Miles Allison
1
, Julie Alexander
1
, Nafees Ali
1
, Seetharam Mannem
1
, Paul Mizen
1
, Inderpal Singh
2
, Jack Wellington
3
, Reem Naji
3
,Alexander
Eggleton
3
, Aine Jones
3
, Megan Stone
3
, Giles Greene
3
, David Fone
3
, Nicholas Doyle
3
1
Aneurin Bevan Local University Health Board (Royal Gwent Hospital),
2
Aneurin Bevan Local University Health Board (Ysbyty Ystrad Fawr Hospital),
3
Cardiff University
Methodologies:
Over a 4-week study period (12th March 2019 - 8th April 2019
weekends inclusive), we identified eligible patients according to a
strict exclusion criteria (Figure 1).
Verbal consent from eligible patients presenting via the acute T&O
intake at the Royal Gwent Hospital was sought for GOAL and 4AT
testing during the study period. A scoring of <8/10 s indicates a “fail”
on the GOAL and any error on the 4AT indicates “possible cognitive
impairment”. (1-2)
Evidence of current or pre-existing Dementia, Epilepsy,
psychiatric/neurological illness in patient documentation was noted
alongside living arrangements.
Background and Introduction:
GOAL iscurrentlyemployedDeliriumandcognitive testing system inMAUat
Royal Gwent Hospital Newport whereas the 4AT assessment is routinely
utilised at Ysbyty Ystrad Fawr Hospital. (1-2) To our knowledge, both exams
haven'tbeen comparedagainst each otherprospectively in relation toequal
patient cohorts. Thus, we aim to evaluate and critically-appraise the GOAL
and4AT testsamongstanequalpatientcohort.Thepresentstudycompares
patient-testing results among acute/emergency T&O admissions against
patient data collected previously presenting via the acute medical intake.
Results:
•
Resultsarebasedona135-patientcohort,allofwhomwereable
toco-operatewithbothscores.Ofthese,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 (Х
2
=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 (Figure 2).
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
1. M.C. Allison, A. Kontoyannis, D. Durai, G.I. Turner, D.L. Fone, GOAL: a
simplified mental test for emergency medical admissions, QJM: An
International Journal of Medicine, Volume 97, Issue 10, October 2004, Pages
663–669.
2. Shenkin SD et al. Protocol for validation of the 4AT, a rapid screening tool
for delirium: a multicentre prospective diagnostic test accuracy study. BMJ
Open. 2018;8(2):e015572.
Acknowledgements:
I would personally like to thank Dr Miles Allison for his supervision
throughout my SSC project, the Royal Gwent Hospital Newport T&O
staff and the Aneurin Bevan Local University Health Board for allowing
this study to be conducted, Alexander Eggleton and Reem Naji for
assisting with the data collection during the study period and previous
collaborators of this study (stated above)