Zoë Tieges1,2, Alasdair M J Maclullich1, Atul Anand1,3, Claire Brookes4, Marica Cassarino4, Margaret O'connor5, Damien Ryan6,7, Thomas Saller8, Rakesh C Arora9,10, Yue Chang9, Kathryn Agarwal11,12, George Taffet11,12, Terence Quinn13, Susan D Shenkin1, Rose Galvin4. 1. Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK. 2. School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK. 3. Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, Scotland, UK. 4. School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland. 5. Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland. 6. Retrieval, Emergency and Disaster Medicine Research and Development Unit (REDSPoT), Emergency Department, University Hospital Limerick, Limerick, Ireland. 7. Graduate Entry Medical School, University of Limerick, Limerick, Ireland. 8. Department of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany. 9. Department of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada. 10. Cardiac Sciences Program, St. Boniface Hospital, Winnipeg, Manitoba, Canada. 11. Section of Geriatrics, Baylor College of Medicine, Houston, TX, USA. 12. Houston Methodist Hospital, Houston, TX, USA. 13. Institute of Cardiovascular Medicine, University of Glasgow, Glasgow, Scotland, UK.
Abstract
OBJECTIVE: Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 'A's Test (4AT) is a short (<2 minutes) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection. METHODS: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the website www.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults (≥65 years); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model. RESULTS: Seventeen studies (3,702 observations) were included. Settings were acute medicine, surgery, a care home and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8-32.1%; range 10.5-61.9%). The pooled sensitivity was 0.88 (95% CI 0.80-0.93) and the pooled specificity was 0.88 (95% CI 0.82-0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77-0.92) and the pooled specificity was 0.89 (95% CI 0.83-0.93). The methodological quality of studies varied but was moderate to good overall. CONCLUSIONS: The 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection. PROSPERO REGISTRATION NUMBER: CRD42019133702.
OBJECTIVE: Detection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 'A's Test (4AT) is a short (<2 minutes) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection. METHODS: We searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the website www.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults (≥65 years); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model. RESULTS: Seventeen studies (3,702 observations) were included. Settings were acute medicine, surgery, a care home and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8-32.1%; range 10.5-61.9%). The pooled sensitivity was 0.88 (95% CI 0.80-0.93) and the pooled specificity was 0.88 (95% CI 0.82-0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77-0.92) and the pooled specificity was 0.89 (95% CI 0.83-0.93). The methodological quality of studies varied but was moderate to good overall. CONCLUSIONS: The 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection. PROSPERO REGISTRATION NUMBER: CRD42019133702.
Authors: Nidhi Rohatgi; Yingjie Weng; Jason Bentley; Maarten G Lansberg; John Shepard; Diana Mazur; Neera Ahuja; Joseph Hopkins Journal: Am J Med Date: 2019-06-20 Impact factor: 4.965
Authors: Anne W S Rutjes; Johannes B Reitsma; Marcello Di Nisio; Nynke Smidt; Jeroen C van Rijn; Patrick M M Bossuyt Journal: CMAJ Date: 2006-02-14 Impact factor: 8.262
Authors: Jo Ellen Wilson; Matthew F Mart; Colm Cunningham; Yahya Shehabi; Timothy D Girard; Alasdair M J MacLullich; Arjen J C Slooter; E Wesley Ely Journal: Nat Rev Dis Primers Date: 2020-11-12 Impact factor: 65.038
Authors: Susan D Shenkin; Christopher Fox; Mary Godfrey; Najma Siddiqi; Steve Goodacre; John Young; Atul Anand; Alasdair Gray; Janet Hanley; Allan MacRaild; Jill Steven; Polly L Black; Zoë Tieges; Julia Boyd; Jacqueline Stephen; Christopher J Weir; Alasdair M J MacLullich Journal: BMC Med Date: 2019-07-24 Impact factor: 8.775
Authors: F Kracht; M Boekholt; F Schumacher-Schönert; A Nikelski; N Chikhradze; P Lücker; H C Vollmar; W Hoffmann; S H Kreisel; J R Thyrian Journal: BMC Geriatr Date: 2021-07-12 Impact factor: 3.921