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2014 ; 43
(4
): 496-502
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Validation of the 4AT, a new instrument for rapid delirium screening: a study in
234 hospitalised older people
#MMPMID24590568
Bellelli G
; Morandi A
; Davis DH
; Mazzola P
; Turco R
; Gentile S
; Ryan T
; Cash H
; Guerini F
; Torpilliesi T
; Del Santo F
; Trabucchi M
; Annoni G
; MacLullich AM
Age Ageing
2014[Jul]; 43
(4
): 496-502
PMID24590568
show ga
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.