荷兰语版 4AT 在混合患者人群和环境中用于检测谵妄的诊断准确性。

Diagnostic accuracy of the Dutch version of the 4AT for delirium detection in a mixed patient population and setting.

机构信息

Department of Geriatric Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.

Amstelland Hospital, Laan van de Helende Meesters 8, 1186 AM, Amstelveen, The Netherlands.

出版信息

Aging Clin Exp Res. 2023 Aug;35(8):1705-1710. doi: 10.1007/s40520-023-02447-2. Epub 2023 Jun 7.

DOI:10.1007/s40520-023-02447-2

PMID:37285074

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10363057/

Abstract

BACKGROUND

Delirium is an acute disturbance in attention, awareness and cognition. Immediate detection in older adults is recommended because delirium is associated with adverse outcomes. The 4 'A's Test (4AT) is a short screening instrument for delirium. The aim of this study is to evaluate diagnostic accuracy of the Dutch version of the screening tool 4AT for delirium detection in different settings.

METHODS

Prospective observational study conducted in two hospitals in patients aged ≥ 65 years in geriatric wards and the Emergency Department (ED). Each participant underwent two assessments; the index test 4AT, followed by the reference standard for delirium performed by a geriatric care specialist. The reference standard delirium is according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria.

RESULTS

A total of 71 geriatric inpatients and 49 older ED patients were included. The prevalence of delirium was 11.6% in the acute geriatric ward and 6.1% in the ED. The sensitivity and specificity of the 4AT in the acute geriatric ward were 0.88 and 0.69, respectively. In the ED, the sensitivity and specificity were 0.67 and 0.83, respectively. The area under the receiver operating characteristic curve was 0.80 for the acute geriatric ward setting and 0.74 for the ED setting.

CONCLUSION

The Dutch version of the 4AT is a reliable screening tool for delirium detection in both acute geriatric wards and ED. Due to its brevity and practicality (i.e., no special training is required to administer the tool), it is useful in clinical practice.

摘要

背景

谵妄是一种注意力、意识和认知的急性障碍。建议对老年人进行即时检测，因为谵妄与不良结局有关。4“A”测试（4AT）是一种用于检测谵妄的简短筛查工具。本研究的目的是评估用于检测不同环境下谵妄的筛查工具 4AT 的荷兰语版本的诊断准确性。

方法

这是一项在两家医院进行的前瞻性观察研究，纳入了老年病房和急诊科（ED）中年龄≥65 岁的患者。每位参与者接受了两次评估；4AT 作为指数测试，然后由老年护理专家进行谵妄的参考标准评估。参考标准的谵妄是根据《精神障碍诊断与统计手册》（DSM-V）标准进行的。

结果

共纳入了 71 名老年住院患者和 49 名老年 ED 患者。急性老年病房的谵妄患病率为 11.6%，ED 的患病率为 6.1%。4AT 在急性老年病房的敏感性和特异性分别为 0.88 和 0.69，在 ED 中的敏感性和特异性分别为 0.67 和 0.83。接受者操作特征曲线下的面积在急性老年病房为 0.80，在 ED 为 0.74。