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

Age and Ageing
Zoë TiegesR. Galvin

Abstract

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. 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. 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...Continue Reading

References

Dec 15, 1990·Annals of Internal Medicine·S K InouyeR I Horwitz
Feb 16, 2006·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Anne W S RutjesPatrick M M Bossuyt
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Dec 25, 2019·Hospital Practice·Katie M RieckDonna M Miller
Feb 18, 2020·Journal of Clinical Nursing·Binu KoiralaPatricia M Davidson

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Citations

Feb 6, 2021·European Geriatric Medicine·Kate GibbDaniel Davis
Apr 7, 2021·Journal of the American Medical Directors Association·Alessandro MorandiGiuseppe Bellelli

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Software Mentioned

R
4AT
Diagnostic Test Accuracy Meta - Analysis
QUADAS

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