A quantifiable, brief mental status examination for emergency patients

Although paramedics and emergency department (ED) personnel are routinely required to assess the mental states of patients they are attempting to treat, no structured and easily administered tool has been validated for their use. The objective of this study was to determine whether a quantitative Brief Mental Status Examination (BMSE) can serve as such a tool. The six-item BMSE was administered to 100 ED patients for whom an assessment of mental status was warranted. The standard assessment of mental status (normal, mildly impaired, or severely impaired) and competence to refuse emergency care were provided by the attending physician. The usefulness and ease of administration of the BMSE were rated by the physicians and nurses administering it. We found that BMSE scores correlated significantly with physicians' assessments of patients' mental status and competence to refuse care. Using physician assessment as a standard, the BMSE had a sensitivity of 72% and a specificity of 95% in identifying severely impaired individuals. Examiners' ratings of ease of administration were closely related to the degree of impairment found. Finally, examiners rated the BMSE as useful in 98% of cases. We conclude from these preliminary results that the BMSE, upon further testing, may prove to be a valid and useful tool for assessing the mental states of emergency patients in both prehospital and ED settings.