Diagnostic test accuracy of screening tools for the detection of neurocognitive disorders in older adults post-trauma in acute care settings: a systematic review.

Abstract

Purpose: Neurocognitive disorders (NCDs), including delirium, cognitive impairment, or dementia, are prevalent in older patients with physical trauma in acute care settings. Identifying NCDs in these patients can enhance care decisions to improve outcomes. This study aimed to identify the diagnostic accuracy of screening tools for NCDs in older patients with trauma in acute care settings.

Methods: Electronic databases (MEDLINE, Embase, CINAHL, PsycInfo, Cochrane Library) were searched from inception to 01 March 2024. Inclusion criteria were: older adults (≥ 60 years); admitted to acute care setting following physical trauma; diagnostic accuracy study of a screening tool for (1) delirium and/or (2) cognitive impairment or dementia against a reference standard of a clinical diagnosis (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A narrative synthesis was conducted. Methodological heterogeneity between the studies precluded meta-analysis.

Results: Five studies examining five different screening tools for delirium in older adults, all with hip fracture, were included. Studies reported wide variance in sensitivity (76.9-91.8) and specificity (54.5-99). Prevalence of detected delirium varied widely across studies (6.7-31.5%). All studies had a high or unclear risk of bias in at least one domain. No studies were found to examine the diagnostic accuracy of screening tools for cognitive impairment in older patients with trauma.

Conclusion: This systematic review highlights the dearth of studies validating screening tools for NCDs in older patients following trauma in acute care settings.

Prospero registration number: CRD42024518730.