GOAL: a simplified mental test for emergency medical admissions.
BACKGROUND
Several scoring systems are used in screening for cognitive impairment, but none are suited to the busy medical assessment environment.


OBJECTIVE
To construct, validate and assess the reliability of a simple scale (Gwent Orientation and Awareness Listing, GOAL) for this purpose, and to examine its application in consecutive emergency admissions in two general hospitals.


METHODS
Prospective cohort studies.


METHODS
The validity and reliability of GOAL was assessed in three studies of patients aged > or =65 years who had been pronounced medically fit for discharge. The evaluation studies were carried out over 4-week medical intake periods in each participating hospital.


RESULTS
Correlation of GOAL with the standard 30-point Mini-Mental State Examination was 0.89, and the inter-observer reliability was 0.90. Based on Receiver Operating Characteristics Curves, patients scoring <8 on GOAL were deemed to be cognitively impaired. Assessment by GOAL took half the time required for the widely used Abbreviated Mental Test Score. Of 1037 consecutive patients admitted to two hospitals' acute medical intakes and remaining for >24 h, 952 were able and willing to be scored by GOAL, and of these 201 (21%) 'failed', with a score of <8.


CONCLUSIONS
Loss of orientation and awareness is common among patients admitted via medical intakes. GOAL is a practical brief screen for identifying and following-up these patients.
Allison
M C
MC
Department of Adult Medicine, Royal Gwent Hospital, Newport, Gwent. miles.allison@gwent.wales.nhs.uk
Kontoyannis
A
A
Durai
D
D
Turner
G I
GI
Fone
D L
DL
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D003072:Cognition Disorders / Q000175:diagnosis* / Q000523:psychology; D004630:Emergencies / Q000523:psychology*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D009949:Orientation; D011446:Prospective Studies; D011581:Psychological Tests; D015203:Reproducibility of Results