GOAL: a simplified mental test for emergency medical admissions

Background: Several scoring systems are used in screening for cognitive impairment, but none are suited to the busy medical assessment environment. Aim: To construct, validate and assess the reliability of a simple scale (Gwent Orientation and Awareness Listing, GOAL) for this purpose, and to examine its application in consecutive emergency admissions in two general hospitals. Design: Prospective cohort studies. Methods: The validity and reliability of GOAL was assessed in three studies of patients aged ≥65 years who had been pronounced medically fit for discharge. The evaluation studies were carried out over 4-week medical intake periods in each participating hospital. Results: Correlation of GOAL with the standard 30-point Mini-Mental State Examination was 0.89, and the inter-observer reliability was 0.90. Based on Receiver Operating Characteristics Curves, patients scoring 24 h, 952 were able and willing to be scored by GOAL, and of these 201 (21%) ‘failed’, with a score of <8. Discussion: Loss of orientation and awareness is common among patients admitted via medical intakes. GOAL is a practical brief screen for identifying and following-up these patients.