1. The 4AT, a rapid delirium detection tool for use in hospice inpatient units: Findings from a validation study.
- Author
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Arnold, Elizabeth, Finucane, Anne M, Taylor, Stacey, Spiller, Juliet A, O'Rourke, Siobhan, Spenceley, Julie, Carduff, Emma, Tieges, Zoë, and MacLullich, Alasdair MJ
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DIAGNOSIS of delirium , *RESEARCH funding , *RESEARCH methodology evaluation , *MENTAL illness , *CLASSIFICATION of mental disorders , *DESCRIPTIVE statistics , *ODDS ratio , *TERMINALLY ill , *MEDICAL screening , *CONFIDENCE intervals , *HOSPICE care , *HOSPITAL wards - Abstract
Background: Delirium is a serious neuropsychiatric syndrome with adverse outcomes, which is common but often undiagnosed in terminally ill people. The 4 'A's test or 4AT (www.the4AT.com), a brief delirium detection tool, is widely used in general settings, but validation studies in terminally ill people are lacking. Aim: To determine the diagnostic accuracy of the 4AT in detecting delirium in terminally ill people, who are hospice inpatients. Design: A diagnostic test accuracy study in which participants underwent the 4AT and a reference standard based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The reference standard was informed by Delirium Rating Scale Revised-98 and tests assessing arousal and attention. Assessments were conducted in random order by pairs of independent raters, blinded to the results of the other assessment. Setting/participants: Two hospice inpatient units in Scotland, UK. Participants were 148 hospice inpatients aged ⩾18 years. Results: A total of 137 participants completed both assessments. Three participants had an indeterminate reference standard diagnosis and were excluded, yielding a final sample of 134. Mean age was 70.3 (SD = 10.6) years. About 33% (44/134) had reference standard delirium. The 4AT had a sensitivity of 89% (95% CI 79%–98%) and a specificity of 94% (95% CI 90%–99%). The area under the receiver operating characteristic curve was 0.97 (95% CI 0.94–1). Conclusion: The results of this validation study support use of the 4AT as a delirium detection tool in hospice inpatients, and add to the literature evaluating methods of delirium detection in palliative care settings. Trial registry: ISCRTN 97417474. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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