Lai Yun-Hsuan, Lin Chia-Jou, Su I-Chang, Huang Sheng-Wen, Hsiao Chia-Chi, Jao Ying-Ling, Chen Pin-Yuan, Traynor Victoria, Lee Chuan-Ya, Chen Ting-Jhen, Ho Mu-Hsing, Chiu Hsiao-Yean
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
J Acad Consult Liaison Psychiatry. 2025 Mar-Apr;66(2):130-138. doi: 10.1016/j.jaclp.2024.12.005. Epub 2025 Jan 4.
Delirium is a common symptom following a traumatic brain injury that is often overlooked by healthcare professionals. Early detection of posttraumatic delirium is crucial to improving patient outcomes and quality of life. The 4 As Test (4AT: alertness, attention, abbreviated mental test-4, and acute mental changes) is a brief and rapid tool for delirium assessment with acceptable reliability and validity. However, the 4AT has not yet been translated for use in the Taiwanese population.
To translate the 4AT into Traditional Chinese (TC-4AT), assess its reliability and validity, and explore the clinical effects of delirium in patients with a traumatic brain injury.
This prospective observational study was conducted at the neurosurgery wards of 2 Taiwanese hospitals. Patients who were aged 20 years or older, were diagnosed with a traumatic brain injury, and had a Glasgow Coma Scale score between 13 and 15 were included. Interrater reliability was assessed, and validity was verified using criterion-related comparisons with the Short Confusion Assessment Method. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were employed to assess the sensitivity and specificity of the TC-4AT for screening posttraumatic brain injury delirium.
A total of 100 patients with an average age of 67 years were enrolled, of whom 10% were diagnosed with delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The interrater reliability of the TC-4AT was 1.00. Patients with delirium tended to have a longer hospital stay than those without delirium (13 days vs. 7 days) although the difference was nonsignificant (P = 0.28). In terms of criterion validity, patients diagnosed with delirium using the Short Confusion Assessment Method had a significantly higher score on the TC-4AT than those not diagnosed with delirium (P < 0.001). The receiver operating characteristic curve indicated that the optimal cutoff point was 4, with sensitivity, specificity, and area under the characteristic curve of 0.90, 0.94, and 0.96, respectively.
The TC-4AT is an accurate tool for delirium assessment that aids early detection and in informed decision-making in preventive care.
谵妄是创伤性脑损伤后的常见症状，常被医护人员忽视。早期发现创伤后谵妄对于改善患者预后和生活质量至关重要。4A测试（4AT：警觉性、注意力、简易精神状态检查表-4和急性精神状态改变）是一种用于谵妄评估的简短快速工具，具有可接受的信效度。然而，4AT尚未被翻译成中文供台湾人群使用。
将4AT翻译成繁体中文（TC-4AT），评估其信效度，并探讨谵妄对创伤性脑损伤患者的临床影响。
这项前瞻性观察性研究在台湾两家医院的神经外科病房进行。纳入年龄在20岁及以上、被诊断为创伤性脑损伤且格拉斯哥昏迷量表评分为13至15分的患者。评估评分者间信度，并通过与简易精神状态检查表进行标准相关比较来验证效度。采用《精神疾病诊断与统计手册》第五版标准评估TC-4AT筛查创伤性脑损伤后谵妄的敏感性和特异性。
共纳入100例平均年龄为67岁的患者，其中10%根据《精神疾病诊断与统计手册》第五版标准被诊断为谵妄。TC-4AT的评分者间信度为1.00。谵妄患者的住院时间往往比无谵妄患者长（13天对7天），尽管差异无统计学意义（P = 0.28）。在标准效度方面，使用简易精神状态检查表诊断为谵妄的患者在TC-4AT上的得分显著高于未诊断为谵妄的患者（P < 0.001）。受试者工作特征曲线表明，最佳截断点为4，敏感性、特异性和特征曲线下面积分别为0.90、0.94和0.96。
TC-4AT是一种准确的谵妄评估工具，有助于早期发现并为预防护理中的明智决策提供依据。
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