Evaluating measurement quality and feasibility of neurocognitive screening instruments for adult survivors of out-of-hospital cardiac arrest: A systematic review

Abstract

AIM: To systematically review and appraise the measurement properties, interpretability, and feasibility of outcome measurement instruments (OMIs) for screening neurocognitive function among adult survivors of out-of hospital cardiac arrest (OHCA). METHODS: Online databases were searched (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO) from inception - August 23, 2024. Included articles evaluated measurement properties, interpretability (assigning meaning to scores), and/or feasibility (ease of application) of multidomain instruments for screening neurocognitive function among OHCA survivors. Evidence was reviewed according to the Consensus-based Standards for the selection of health status Measurement Instruments (COSMIN) guidelines: Risk of Bias determined study quality; COSMIN criteria for good measurement properties was applied; data were pooled where possible, finally, the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria rated the certainty of evidence. RESULTS: Of 2336 titles and abstracts, 27 articles provided evidence for 13 instruments (MoCA, T-MoCA, Mini MoCA, MMSE, MMSE-ALFI, 3MS, TICS, TICS-m, WASI, IQCODE, IQCODE-CA, SF-16 IQCODE-CA, and CFQ). Only three reported measurement properties for two OMIs: the MoCA and the IQCODE-CA. The MoCA demonstrated high quality evidence of criterion validity across two studies (pooled AUC: 0.80; 95% CI: 0.67 to 0.93). There were inconsistent results for the IQCODE-CA. There was limited evidence of score interpretability and feasibility across all 13 OMIs. CONCLUSIONS: Insufficient evidence of essential measurement properties limits instrument choice. Whilst the MoCA had acceptable criterion validity, evidence of content validity was inadequate, and reliability and responsiveness lacking. Establishing robust evidence to inform screening of neurocognitive function in this population should be prioritized. Source: Theresa Aves et al. Resuscitation (2025). https://doi.org/10.1016/j.resuscitation.2025.110793. Reproduced under CC BY-NC-ND 4.0: https://creativecommons.org/licenses/by-nc-nd/4.0/. Abstract wording unchanged; section-heading formatting adapted.