Geriatric Medicine, Edinburgh Delirium Research Group, Royal Infirmary of Edinburgh, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh 51, Little France Crescent, Edinburgh, EH16 4SA, UK.
Norwich Medical School, University of East Anglia, Norfolk, UK.
BMC Med. 2019 Jul 24;17(1):138. doi: 10.1186/s12916-019-1367-9.
Delirium 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).
This 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.
Eight 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%).
The 4AT is a short, pragmatic tool which can help improving detection rates of delirium in routine clinical care.
International standard randomised controlled trial number (ISRCTN) 53388093 . Date applied 30/05/2014; date assigned 02/06/2014.
谵妄影响超过 15%的住院患者，但严重漏诊，导致护理质量下降。4' A '测试（4AT，www.the4AT.com）是一种用于常规使用的简短谵妄评估工具，无需特殊培训。主要目的是评估 4AT 对谵妄检测的准确性。次要目标是将 4AT 与另一种常用的谵妄评估工具——意识模糊评估法（CAM）进行比较。
这是一项前瞻性诊断性试验准确性研究，在急诊科或急性内科病房进行，涉及年龄≥70 岁的急性内科患者。所有无急性生命威胁性疾病或昏迷的患者均符合条件。患者接受了（1）基于 DSM-IV 标准的参考标准谵妄评估，以及（2）随机接受指数测试（4AT，评分 0-12；预设评分>3 为阳性）或比较器（CAM；评分阳性或阴性），使用计算机生成的伪随机数，按研究地点分层，采用区组随机化，参考标准和 4AT 或 CAM 评估由两对独立的盲法评估者进行。
843 名患者被随机分配：21 名退出，3 名失联，32 名诊断不确定，2 名失访，785 名患者纳入分析。平均年龄为 81.4（SD 6.4）岁。12.1%（95/785）经参考标准评估为谵妄，14.3%（56/392）为 4AT，4.7%（18/384）为 CAM。4AT 的受试者工作特征曲线下面积为 0.90（95%CI 0.84-0.96）。4AT 的灵敏度为 76%（95%CI 61-87%），特异性为 94%（95%CI 92-97%）。CAM 的灵敏度为 40%（95%CI 26-57%），特异性为 100%（95%CI 98-100%）。
4AT 是一种简短的实用工具，可以帮助提高常规临床护理中谵妄的检出率。
国际标准随机对照试验编号（ISRCTN）53388093。申请日期 2014 年 5 月 30 日；分配日期 2014 年 6 月 2 日。
Zotero 插件
