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FMSE: Fluctuating Mental Status Evaluation

2023

A five-domain neurocritical-care screen that rates fluctuation from an established post-injury cognitive baseline. It is designed to reduce confounding from fixed focal deficits such as aphasia.

At a glance

Purpose
Episodic assessment
Population
Adult
Setting
Intensive care
Time
approximately 1 min after relevant observations are available
Items
5
Score or threshold
1 or more indicates possible delirium; 2 or more indicates probable delirium in published neurocritical-care studies

Format: Five binary domain ratings summarise changes in consciousness, orientation, activity, thought content and attention over a defined observation period. The 0-5 total depends on establishing an appropriate neurological baseline;

Primary validation papers

2 identified diagnostic-accuracy papers

Other forms of validation are described in the evidence section. What is counted?

Large-scale clinical implementation

Not yet reviewed.

A focused implementation review has not yet been completed for this profile.

Training and instructions

Public training resources have not yet been confirmed in this review. Check the linked developer or original source for instructions.

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Tool and original sources

No direct copy is linked here. The original paper and a Google Images search are available below. Image results may be unofficial; check the version and source before use.

Read the full paper ↗ Search Google Images ↗

Original and selected diagnostic-accuracy papers

  • Original paperReznik ME, Margolis SA, Moody S, Drake J, Tremont G, Furie KL, et al. A Pilot Study of the Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool for Neurocritical Care Patients. Neurocritical care. 2023;38(2):388-394. doi: 10.1007/s12028-022-01612-1. PMID: 36241773.

    This is the original published source for FMSE. It reported sensitivity of 86% and specificity of 73% against an independent DSM-5 clinical assessment.

    Open PubMed ↗
  • Selected diagnostic-accuracy studyReznik ME, Margolis SA, Andrews N, Basso C, Mintz N, Varga S, et al. Validating the Fluctuating Mental Status Evaluation in Neurocritically Ill Patients With Acute Stroke. Critical care medicine. 2024;52(12):1918-1927. doi: 10.1097/CCM.0000000000006437. PMID: 39365697.

    This diagnostic-accuracy study evaluated FMSE in academic neurocritical-care unit against an independent DSM-5 clinical assessment. It reported sensitivity of 86% and specificity of 74% in 139 neurocritically ill stroke patients; 717 paired non-comatose patient-days.

    Open PubMed ↗
Multiple DTA studies identifiedCore instrument family
Classification

Classification

Episodic assessmentMonitoring for new onset deliriumUse in intensive care units

A tool may belong to more than one category. Select a linked category to see other relevant profiles.

Evidence

Diagnostic-accuracy evidenceMultiple DTA studies identified

Reported sensitivity and specificity

Headline metric source

Original/source study · 2023; pmid:36241773

Denominator
Reported source unit: 40 (analysis unit not fully reconciled)
Reference standard
Expert DSM-5 delirium ratings
86%
Sensitivity
73%
Specificity

Earliest DTA evaluation identified in the current audit; see the linked source and methodological caveats.

More evidence and citation details
Full name
Fluctuating Mental Status Evaluation
Also known as
FMSE
Evidence summary
external-validation
Diagnostic-accuracy evaluations
2
Reference standard
Expert DSM-5 delirium ratings
Citation
Reznik ME, Margolis SA, Moody S, Drake J, Tremont G, Furie KL, Mayer SA, Ely EW, Jones RN A Pilot Study of the Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool for Neurocritical Care Patients Neurocritical care. 2023;38(2):388-394. PMID 36241773
Download RIS ↗ Download BibTeX ↗

Primary validation studies

Distinct primary publications from the current diagnostic-accuracy audit. Reviews and repeated evaluations within one paper are not counted again. Overlapping cohorts have not all been reconciled. Read the counting rules and limitations.

Open 2 identified papers
  1. Reznik ME, Margolis SA, Moody S, Drake J, Tremont G, Furie KL, Mayer SA, Ely EW, Jones RN (2023). A Pilot Study of the Fluctuating Mental Status Evaluation: A Novel Delirium Screening Tool for Neurocritical Care Patients. Neurocritical care.

    Reference category: independent clinical reference.

  2. Reznik ME, Margolis SA, Andrews N, Basso C, Mintz N, Varga S, Snitz BE, Girard TD, Shutter LA, Ely EW, Jones RN (2024). Validating the Fluctuating Mental Status Evaluation in Neurocritically Ill Patients With Acute Stroke. Critical care medicine.

    Reference category: independent clinical reference.

Copyright and reuse
Information checked
2026-07-19

Instrument-specific terms apply. See the access and copyright policy or send a correction.

Base clinical review: 2026-07-29. Instrument description source check: 2026-09-05. Scope and limitations.