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Society of Critical Care Medicine recommended screening tools to detect long-term cognition, mental health, and physical function after critical illness

Society of Critical Care Medicine recommended screening tools to detect long-term cognition, mental health, and physical function after critical illness
Domain Screening test Comments Recommendation
Cognition Montreal Cognitive Assessment (MoCA)[1-4] Mild cognitive impairment defined as a score of 18 to 25, moderate as 10 to 17, and severe as less than 10 Strong
Anxiety HADS[2,5] A score of 8 or greater on the anxiety or depression subscale is used to identify symptoms of clinically significant anxiety or depression Strong
Depression HADS[2,5] Strong
Posttraumatic stress disorder IES-R[6] or the abbreviated IES-6[7,8] The optimal screening threshold has been established as 1.6 (IES-R)[2] or 1.75 (IES-6)[7] Weak
Physical function 6-min walk[9-11] and/or EuroQol-5D-5L[12] Can be evaluated as a percent predicted against available normative data Weak
Includes assessments of mobility, self-care, and usual activities, in addition to pain and anxiety/depression Weak
HADS: Hospital Anxiety and Depression Scale; IES-6: Impact of Event Scale-6; IES-R: Impact of Event Scale-Revised.
References:
  1. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 53:695.
  2. Needham DM: Improving Long-Term Outcomes Research for Acute Respiratory Failure. Instruments. Available at: https://www.improvelto.com/instruments (Accessed on January 15, 2020).
  3. Mehrholz J, Mückel S, Oehmichen F, et al. First results about recovery of walking function in patients with intensive care unit-acquired muscle weakness from the General Weakness Syndrome Therapy (GymNAST) cohort study. BMJ Open 2015; 5:e008828.
  4. Stienen MN, Geisseler O, Velz J, et al. Influence of the intensive care unit environment on the reliability of the montreal cognitive assessment. Front Neurol 2019; 10:734.
  5. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67:361.
  6. DS, Marmar CR. Wilson JP, Keane TM. The impact of event scale-revised. Assessing Psychological Trauma and PTSD. 1997 New York, NY, Guilford. p 399.
  7. Hosey MM, Leoutsakos JS, Li X, et al. Screening for posttraumatic stress disorder in ARDS survivors: Validation of the Impact of Event Scale-6 (IES-6). Crit Care 2019; 23:276.
  8. Bienvenu OJ, Williams JB, Yang A, et al. Posttraumatic stress disorder in survivors of acute lung injury. Chest 2013; 144:24.
  9. ATS Statement. Guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002; 166:111.
  10. Chan KS, Pfoh ER, Denehy L, et al. Construct validity and minimal important difference of 6-minute walk distance in survivors of acute respiratory failure. Chest 2015; 147:1316.
  11. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med 1998; 158:1384.
  12. The EuroQol Group. EuroQol--a new facility for the measurement of health-related quality of life. Health Policy 1990; 16:199.

From: Mikkelsen ME, Still M, Anderson BJ, et al. Society of Critical Care Medicine's International Consensus Conference on Prediction and Identification of Long-Term Impairments After Critical Illness. Crit Care Med 2020; 48:1670. DOI: 10.1097/CCM.0000000000004586. Copyright © 2020 Society of Critical Care Medicine. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.

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