4AT 对老年人谵妄检测的诊断准确性：系统评价和荟萃分析。

Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis.

机构信息

Geriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.

School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.

出版信息

Age Ageing. 2021 May 5;50(3):733-743. doi: 10.1093/ageing/afaa224.

DOI:10.1093/ageing/afaa224

PMID:33951145

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8099016/

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.

摘要

目的

国家和国际指南均建议对住院老年患者进行谵妄检测。4“ A”测试（4AT）是一种简短（<2分钟）的谵妄检测工具，在国际上被用作临床实践中的标准工具。我们对 4AT 检测谵妄的诊断测试准确性进行了系统评价和荟萃分析。

方法

我们检索了 MEDLINE、EMBASE、PsycINFO、CINAHL、clinicaltrials.gov 和 Cochrane 对照试验中心注册库，检索时间从 2011 年（4AT 在网站 www.the4AT.com 发布的年份）到 2019 年 12 月 21 日。纳入标准为：年龄≥65 岁；4AT 指数测试与谵妄参考标准（标准诊断标准或验证工具）相比的诊断准确性研究。使用诊断准确性研究质量评估工具 2 对方法学质量进行评估。使用双变量随机效应模型生成敏感性和特异性的汇总估计值。

结果

纳入了 17 项研究（3702 项观察）。研究地点为急症医学、外科、养老院和急诊科。有 3 项研究评估了 4AT 在中风中的表现。谵妄的总体患病率为 24.2％（95％CI 17.8-32.1％；范围 10.5-61.9％）。汇总敏感性为 0.88（95％CI 0.80-0.93），汇总特异性为 0.88（95％CI 0.82-0.92）。排除中风研究后，汇总敏感性为 0.86（95％CI 0.77-0.92），汇总特异性为 0.89（95％CI 0.83-0.93）。研究的方法学质量各不相同，但总体上为中等至良好。