Published Work by AGEM Members

 

AGEM Author Spotlight: Chris Carpenter, MD, Department of Emergency Medicine at Mayo Clinic - Rochester

Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments

The 2014 Geriatric Emergency Department Guidelines (http://pmid.us/24746437) are being updated using GRADE methodology (https://www.saem.org/publications/grace) and the management of delirium is the first topic in line (https://gearnetwork.org/geriatric-emergency-department-ged-guidelines/). This systematic review and meta-analysis quantitatively synthesizes the diagnostic accuracy of history, physical exam, clinician gestalt, and delirium detection instruments in emergency department settings, while contemplating test-treatment thresholds to optimize the potential benefits of identifying delirium and minimize the potential harms of screening while remaining cognizant of emerging health equity blindspots (http://pmid.us/38994587) and legitimate concerns for a pragmatic approach (http://pmid.us/35277967).  The pooled results indicated that the 4 A's test is currently superior to rule-in (likelihood ratio positive 7.5) and rule-out (likelihood ratio negative 0.18) delirium, although a handful of other instruments may accurately rule-in or rule-out delirium.  These findings will form the foundation for the Geriatric Emergency Department Guidelines 2.0 GRADE recommendations for delirium screening in the ED.

Dr. Carpenter's research interests include diagnostics, geriatric emergency medicine, and implementation science.  He is Deputy Editor-in-Chief of Academic Emergency Medicine, as well as Associate Editor for both the Journal of the American Geriatrics Society and Annals of Internal Medicine’s ACP Journal Club and he serves on the SAEM Foundation Board of Trustees.  He co-led the collaboration to develop the American College of Emergency Physician/American Geriatrics Society Geriatric Emergency Department Guidelines in 2014  the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network’s Standards for Reporting of Implementation Research (StaRI) reporting guidelines in 2017. He serves on the National Institute of Aging Clinician-Scientists Transdisciplinary Aging Research Leadership Core (https://clin-star.org).He also developed and leads the SAEM Guidelines for Reasonable and Appropriate Care in Emergency Departments (GRACE, see https://www.saem.org/publications/academic-emergency-medicine/grace) clinical practice guidelines.  He is a co-Investigator and Implementation Science Core Lead for the Geriatric Emergency care Applied Research Network (GEAR, see https://gearnetwork.org/) and Geriatric Emergency Department Collaborative (https://gedcollaborative.com/), and he chairs the American College of Emergency Physician’s Geriatric Emergency Department Accreditation Advisory Board (https://www.acep.org/geda/).