Use of the Abbreviated Mental Test Score by junior doctors on patients with fractured neck of femur

Abstract

The mental state of patients with fractured neck of femur is important as a predictor of post-operative outcome. The Hodgkinson Abbreviated Mental Test Score (AMTS) is a validated and simple method of assessing the pre-operative mental state of patients with fractured neck of femur. This survey investigated whether or not orthopaedic junior doctors (SHOs) appreciated the importance of mental state assessment in patients with fractured neck of femur and whether they were able to recall the questions used in the AMTS. A total of 47 on-call orthopaedic and trauma SHOs from the UK were randomly contacted by telephone and agreed to answer questions from a standard questionnaire to assess awareness of the ten-question AMTS. A total of 96% of SHOs claimed awareness of the importance of mental state assessment; 89% used the AMTS in their practice, of which 26% were aided by a pro forma. A mean of five (out of the ten) standard questions on the AMTS were correctly identified (95% CI = 0.68); 11% correctly identified all 10 questions. There was no correlation between use of a pro forma and correct identification of questions. Patients with fractured neck of femur and low AMTS have higher morbidity and mortality. If the AMTS is to be used as an assessment tool in this setting, then SHOs need to be better informed and educated as to its use. Furthermore, the validity of data collection for research and audit purposes is potentially flawed; as data collected using such scoring systems may be inaccurate.