A Survey of the Form of the Mental Status Examination Administered by Emergency Physicians

The mental status examination (MSE) is an integral and universal tool of medicine. We studied the form and content of the MSE performed by emergency physicians. An 11-item questionnaire was developed to determine the indications, amount of time necessary to evaluate mental status, the content of MSEs utilized, and the ideal characteristics of a short, standardized MSE. A study group of a random sample of 120 of 1,174 American Board of Emergency Medicine-certified emergency physicians and a validation group were surveyed by questionnaire, which was returned by 80% and 62%, respectively. Emergency physicians agreed that there are numerous specific indications to evaluate mental status including head injury (99%), behavioral abnormality (98%), drug ingestion (96%), and psychiatric complaint (95%); however, few would test it in abdominal pain (21%) or extremity injury (17%). Seventy-two percent take less than five minutes to evaluate mental status in the emergency department. Most emergency physicians uniformly test the same set of items selected from the formal MSE, including level of consciousness (95%); orientation to time (87%), place (86%), and person (84%); spontaneous speech (80%); and behavioral observation (72%) to evaluate mental status. Almost all of the physicians (82%) perceived a need for, and would use, a short standardized MSE that would take less than five minutes to perform. Results from the validation group confirmed the accuracy of the survey technique used. Our study demonstrated a perceived need for a short, standardized MSE in emergency medicine.