Diagnostic test accuracies of 4AT items are consistent across the range of baseline cognition: results from two prospective studies.
Background Presenting features of delirium can be difficult to distinguish from co-existing dementia phenomenology. While the 4 'A's Test (4AT) is a well validated delirium screening tool across multiple patient populations and healthcare settings, how its diagnostic performance varies across differ...
| Publicado en: | Age & Ageing Vol. 55; no. 6; pp. 1 - 10 |
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| Autores principales: | , , , , , , , , , |
| Formato: | Artículo |
| Publicado: |
Oxford University Press / USA
Jun2026
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=195099730&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 195099730 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00020729 AGA jtl: Age & Ageing issn: 00020729 maglogo: N pubinfo: dt: Jun2026 vid: 55 iid: 6 pid: 622 pub: Oxford University Press / USA artinfo: ui: 195099730 10.1093/ageing/afag182 ppf: 1 ppct: 9 formats: tig: atl: Diagnostic test accuracies of 4AT items are consistent across the range of baseline cognition: results from two prospective studies. aug: au: Hogan, Patrick Cheston, Hannah Dunne, Ophelia Gardner, Dominic McWhirter, Amy Rawle, Mark James Stoodley, Imogen Richardson, Sarah Joanna Allan, Louise M MacLullich, Alasdair M J affil: Institute of Health Informatics, University College London, UK Care of the Elderly, Whipps Cross University Hospital, London, England, UKInstitute of Cardiovascular Science, MRC Unit for Lifelong Health and Ageing, 1-19 Torrington Place, London, WC1E 7HB, UK Translational and Clinical Research Institute, Newcastle University, 3rd floor Biomedical Research Building Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK Centre for Research in Ageing and Cognitive Health, University of Exeter, St Luke's Campus Heavitree Road, Exeter, EX1 2LU, UK Geriatric Medicine, University of Edinburgh MED, F1424, Royal Infirmary of Edinburgh 51, Little France Crescent, Edinburgh, EH16 4SA, UK su: Classification of mental disorders Medical screening Diagnosis of delirium Cognitive testing Research funding Secondary analysis Receiver operating characteristic curves Descriptive statistics Longitudinal method Confidence intervals Data analysis software Dementia Sensitivity & specificity (Statistics) sug: subj: Classification of mental disorders Medical screening All Other Miscellaneous Ambulatory Health Care Services Diagnosis of delirium Cognitive testing Research funding Secondary analysis Receiver operating characteristic curves Descriptive statistics Longitudinal method Confidence intervals Data analysis software Dementia Sensitivity & specificity (Statistics) keyword: cognition copyrightHolder:British Geriatrics Society copyrightYear:2026 delirium dementia diagnosis diagnostic techniques and procedures https://dx.doi.org/10.1093/ageing/afag182 inLanguage:en older people publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42341202/ cognition copyrightHolder:British Geriatrics Society copyrightYear:2026 delirium dementia diagnosis diagnostic techniques and procedures https://dx.doi.org/10.1093/ageing/afag182 inLanguage:en older people publisher:Oxford University Press sameAs:https://pubmed.ncbi.nlm.nih.gov/42341202/ ab: Background Presenting features of delirium can be difficult to distinguish from co-existing dementia phenomenology. While the 4 'A's Test (4AT) is a well validated delirium screening tool across multiple patient populations and healthcare settings, how its diagnostic performance varies across different levels of baseline cognition is unclear. Methods This study harmonises data from two prospective cohorts: the Delirium and Population Health Informatics Cohort (DELPHIC) and Delirium and Cognitive Impact in Dementia (DECIDE). Both cohorts were stratified into tertiles according to baseline cognition. Delirium was defined using DSM-IV (DELPHIC) and DSM-V (DECIDE). 4AT domain scores were operationalised from relevant delirium assessments within each study (MDAS, OSLA, months of the year backwards); item 4 was drawn from assessments of fluctuation. This process yielded an operationalised 4AT. Diagnostic accuracy of the operationalised 4AT was calculated using sensitivity, specificity, and receiver operating characteristics, with pooled estimates for each test domain. Results Among 396 unique participants and 2468 assessments across both studies, pooled 4AT sensitivity and specificity were 0.73 and 0.89, respectively. Overall 4AT performance was consistent across cognitive tertiles (sensitivity: high 0.82, middle 0.73, low 0.71; specificity: high 0.91; middle 0.92; low 0.86). Conclusions The operationalised 4AT showed good diagnostic performance in all three levels of baseline cognition. Sensitivity would likely have been higher had clinical information to inform 4AT item 4 been available. Overall, however, the findings support the value of bedside 4AT items in detecting delirium in hospitalised patients across the spectrum of baseline cognition. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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