title: Prospective Validation of the Ottawa 3DY Scale by Geriatric Emergency Management Nurses to Identify Impaired Cognition in Older Emergency Department Patients.
abstract: OBJECTIVE
  Assessment of older emergency department (ED) patients with cognitive impairment is challenging because few tools exist that can be quickly administered by front-line practitioners. Our objective is to validate the Ottawa 3DY Scale, a 4-question screening tool for cognitive impairment, in older ED patients and compare its performance with that of the Animal Fluency Test.
  
  
  METHODS
  We conducted a prospective cohort study in 2 EDs and enrolled a convenience sample of patients aged 75 years or older with no history of cognitive impairment. Eligible patients were assessed by geriatric emergency management nurses who administered the Mini-Mental State Examination, ordered with the Ottawa 3DY Scale questions first, followed by the Animal Fluency Test. Mini-Mental State Examination score less than 25 was our criterion standard for cognitive impairment.
  
  
  RESULTS
  Study patients (N=238) had a mean age of 81.9 years and were 60.1% women, and 26.5% were admitted to the hospital. The Ottawa 3DY Scale and Mini-Mental State Examination were in agreement for 75.6% of cases, with a sensitivity of 93.8% (95% confidence interval [CI] 77.8% to 98.9%) and specificity of 72.8% (95% CI 66.1% to 78.7%). The Animal Fluency Test score less than 15 and Mini-Mental State Examination score were in agreement for 46.2% of cases, with sensitivity 90.6% (95% CI 73.8% to 97.5%) and specificity 39.3% (95% CI 32.7% to 46.4%).
  
  
  CONCLUSIONS
  Both the Ottawa 3DY Scale and the Animal Fluency Test demonstrated excellent sensitivity versus the Mini-Mental State Examination; however, the Animal Fluency Test exhibited poor specificity. The Ottawa 3DY Scale is an effective tool to screen for cognitive impairment in older ED patients, and its use may facilitate improved care in this vulnerable population.
authors.affiliation: The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: lwilding@toh.on.ca.
authors.forename: Laura
authors.initials: L
authors.lastname: Wilding
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Debra
authors.initials: D
authors.lastname: Eagles
authors.affiliation: Regional Geriatric Program of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada; Division of Geriatric Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Frank
authors.initials: F
authors.lastname: Molnar
authors.affiliation: The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Jo-Anne
authors.initials: JA
authors.lastname: O'Brien
authors.affiliation: Division of Geriatric Medicine, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: William B
authors.initials: WB
authors.lastname: Dalziel
authors.affiliation: The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Joy
authors.initials: J
authors.lastname: Moors
authors.affiliation: Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Ian
authors.initials: I
authors.lastname: Stiell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000175:diagnosis*; D016529:Emergency Nursing; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009864:Ontario; D011446:Prospective Studies; D012680:Sensitivity and Specificity