Dataset Information

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people.

ABSTRACT:

Objective

to evaluate the performance of the 4 'A's Test (4AT) in screening for delirium in older patients. The 4AT is a new test for rapid screening of delirium in routine clinical practice.

Design

: prospective study of consecutively admitted elderly patients with independent 4AT and reference standard assessments.

Setting

: an acute geriatrics ward and a department of rehabilitation.

Participants

two hundred and thirty-six patients (aged ?70 years) consecutively admitted over a period of 4 months.

Measurements

in each centre, the 4AT was administered by a geriatrician to eligible patients within 24 h of admission. Reference standard delirium diagnosis (DSM-IV-TR criteria) was obtained within 30 min by a different geriatrician who was blind to the 4AT score. The presence of dementia was assessed using the Alzheimer's Questionnaire and the informant section of the Clinical Dementia Rating scale. The main outcome measure was the accuracy of the 4AT in diagnosing delirium.

Results

patients were 83.9 ± 6.1 years old, and the majority were women (64%). Delirium was detected in 12.3% (n = 29), dementia in 31.2% (n = 74) and a combination of both in 7.2% (n = 17). The 4AT had a sensitivity of 89.7% and specificity 84.1% for delirium. The areas under the receiver operating characteristic curves for delirium diagnosis were 0.93 in the whole population, 0.92 in patients without dementia and 0.89 in patients with dementia.

Conclusions

the 4AT is a sensitive and specific method of screening for delirium in hospitalised older people. Its brevity and simplicity support its use in routine clinical practice.

SUBMITTER: Bellelli G

PROVIDER: S-EPMC4066613 | biostudies-literature | 2014 Jul

REPOSITORIES: biostudies-literature

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Publications

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people.

Bellelli Giuseppe G Morandi Alessandro A Davis Daniel H J DH Mazzola Paolo P Turco Renato R Gentile Simona S Ryan Tracy T Cash Helen H Guerini Fabio F Torpilliesi Tiziana T Del Santo Francesco F Trabucchi Marco M Annoni Giorgio G MacLullich Alasdair M J AM

Age and ageing 20140302 4

<h4>Objective</h4>to evaluate the performance of the 4 'A's Test (4AT) in screening for delirium in older patients. The 4AT is a new test for rapid screening of delirium in routine clinical practice.<h4>Design</h4>: prospective study of consecutively admitted elderly patients with independent 4AT and reference standard assessments.<h4>Setting</h4>: an acute geriatrics ward and a department of rehabilitation.<h4>Participants</h4>two hundred and thirty-six patients (aged ≥70 years) consecutively a ...[more]

PMID: 24590568

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Project description:BackgroundDelirium is a clinical condition characterised by acute and fluctuating deterioration of the cognitive state, generally secondary to an acute pathology. Delirium is associated with negative outcomes in older adults, such as longer hospitalisations, higher mortality, and short and medium-term institutionalisation. Randomised clinical trials have shown that delirium is preventable through non-pharmacological prevention measures, decreasing its incidence by 30-50%. These interventions include promoting physical activity, facilitating the use of glasses and hearing aids, cognitive stimulation, and providing frequent reorientation of time and space, among others. These measures are currently seldom applied in hospitals in Chile and around the world for reasons including the heavy workload of clinical staff, the lack of trained personnel, and in general the absence of a systematic implementation processes. We developed a software called PREVEDEL, which includes non-pharmacological strategies such as cognitive stimulation, early mobilisation, orientation, and pain assessment. We propose a randomised clinical trial to evaluate whether cognitive stimulation guided by PREVEDEL software prevents delirium status (full/subsyndromal delirium) in hospitalised older adults.MethodA randomised controlled trial, with parallel, multicentre groups. We will recruite patients 65 years or older who have been hospitalised for less than 48 h in the general ward or the intermediate care units of four hospitals in Santiago, Chile. The participants in the intervention group will use a tablet with cognitive stimulation software for delirium prevention for five continuous days versus the control group who will use the tablet without the software. We will evaluate the incidence, duration, density of delirium, subsyndromal delirium with the Confusion Assessment Method, cognitive with the Montreal Cognitive Assessment, and functional status with the Functional Independence Measure at discharge. Moreover, we will evaluate the adherence to prevention measures, as well as demographic variables of interest.DiscussionThe use of cognitive PREVEDEL software could increase and improve the implementation of non-pharmacological prevention measures for delirium in hospitalised older adults, thus reducing its incidence and contributing to patients and health professionals.Trial registrationNCT05108207 ClinicalTrials.gov. Registered 4 November 2021.

Project description:BackgroundDelirium affects > 15% of hospitalised patients but is grossly underdetected, contributing to poor care. The 4 'A's Test (4AT, www.the4AT.com ) is a short delirium assessment tool designed for routine use without special training. The primary objective was to assess the accuracy of the 4AT for delirium detection. The secondary objective was to compare the 4AT with another commonly used delirium assessment tool, the Confusion Assessment Method (CAM).MethodsThis was a prospective diagnostic test accuracy study set in emergency departments or acute medical wards involving acute medical patients aged ≥ 70. All those without acutely life-threatening illness or coma were eligible. Patients underwent (1) reference standard delirium assessment based on DSM-IV criteria and (2) were randomised to either the index test (4AT, scores 0-12; prespecified score of > 3 considered positive) or the comparator (CAM; scored positive or negative), in a random order, using computer-generated pseudo-random numbers, stratified by study site, with block allocation. Reference standard and 4AT or CAM assessments were performed by pairs of independent raters blinded to the results of the other assessment.ResultsEight hundred forty-three individuals were randomised: 21 withdrew, 3 lost contact, 32 indeterminate diagnosis, 2 missing outcome, and 785 were included in the analysis. Mean age was 81.4 (SD 6.4) years. 12.1% (95/785) had delirium by reference standard assessment, 14.3% (56/392) by 4AT, and 4.7% (18/384) by CAM. The 4AT had an area under the receiver operating characteristic curve of 0.90 (95% CI 0.84-0.96). The 4AT had a sensitivity of 76% (95% CI 61-87%) and a specificity of 94% (95% CI 92-97%). The CAM had a sensitivity of 40% (95% CI 26-57%) and a specificity of 100% (95% CI 98-100%).ConclusionsThe 4AT is a short, pragmatic tool which can help improving detection rates of delirium in routine clinical care.Trial registrationInternational standard randomised controlled trial number (ISRCTN) 53388093 . Date applied 30/05/2014; date assigned 02/06/2014.

Dataset Information

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people.

Objective

Design

Setting

Participants

Measurements

Results

Conclusions

Publications

Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people.

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