title: Reliability and validity of prehospital case finding for depression and cognitive impairment.
abstract: OBJECTIVE
  To evaluate the test-retest reliability, the concurrent criterion validity, and the construct validity of prehospital, emergency medical service (EMS) case finding for depression and cognitive impairment in older adults.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Prehospital EMS system and hospital emergency department.
  
  
  METHODS
  EMS providers and community-dwelling older adult (aged > or =60) patients.
  
  
  METHODS
  Case finding instruments for depression (Patient Health Questionnaire-2; PHQ-2) and cognitive impairment (Six-Item Screener).
  
  
  METHODS
  The reliability and validity of these instruments.
  
  
  RESULTS
  Moderate test-retest reliability was found for prehospital application of the PHQ-2 (kappa=0.50) and Six-Item Screener (kappa=0.52), fair concurrent criterion validity for depression (kappa=0.36), and slight to fair concurrent criterion validity for cognitive impairment (kappa=0.11-0.23). Construct validity was demonstrated using the Multitrait-Multimethod Matrix.
  
  
  CONCLUSIONS
  Moderate test-retest reliability and construct validity were demonstrated for prehospital case finding by EMS providers for cognitive impairment and depression using these instruments. Slight to fair concurrent criterion validity was found, a result that methodological limitations could explain. These findings provide additional support for the concept of using EMS providers to detect older adults at risk for these conditions. Further work is needed to confirm the validity and effectiveness of prehospital screening before such programs are implemented.
authors.affiliation: Department of Emergency Medicine, University of Rochester Medical Center, Rochester, New York, USA. manish.shah@rochester.edu
authors.forename: Manish N
authors.initials: MN
authors.lastname: Shah
authors.forename: Jurgis
authors.initials: J
authors.lastname: Karuza
authors.forename: Erik
authors.initials: E
authors.lastname: Rueckmann
authors.forename: Peter
authors.initials: P
authors.lastname: Swanson
authors.forename: Yeates
authors.initials: Y
authors.lastname: Conwell
authors.forename: Paul
authors.initials: P
authors.lastname: Katz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D003072:Cognition Disorders / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis*; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D009518:New York; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires