The 4AT in guidelines
The 4AT is recommended in multiple guidelines, pathways and other guidance provided by governmental bodies and professional societies. Here is list of selected links (under construction) to guidance recommending the 4AT in various clinical settings.
International
Postoperative delirium
European Society of Anaesthesiology: Guideline on postoperative delirium in adult patients [see Supplement Table S2]
Consensus group, Ethiopia: Evidence-Based Guideline on Management of Postoperative Delirium in Older People for Low Resource Setting
United Kingdom
General
NICE (National Institute for Health and Care Excellence, UK): Delirium: prevention, diagnosis and management in hospital and long-term care. In the 2023 update, the 4AT is main recommended tool for general settings, replacing the Confusion Assessment Method (CAM). The CAM-ICU and ICDSC are recommended for ICU settings.
SIGN (Scottish Intercollegiate Guidelines Network, Scotland): Risk reduction and management of delirium. 2019, updated 2022. The 4AT is the main recommended tool for general settings; the CAM-ICU is recommended for ICU settings.
Emergency department
Royal College of Emergency Medicine: Care for Older People in the Emergency Department
Hip fracture
National Hip Fracture Database. Recommendations for hip fracture care
Palliative care
British Geriatrics Society: End of life care in delirium
Marie Curie: Delirium in palliative care
Ireland
General
Health Service Executive: Early Identification and Management of Delirium in the Emergency Department/Acute Medical Assessment Unit
Emergency department
Irish Association for Emergency Medicine (IAEM). Management of Delirium in the Emergency Department
United States
General
American Nurses Association. Delirium: Prevent, Identify, and Treat
Perioperative care
American Society of Anesthesiologists (ASA) Perioperative Brain Health Initiative. Improving perioperative brain health: an expert consensus review of key actions for the perioperative care team
Canada
Emergency department
Canadian Association of Emergency Physicians Position Statement: Care of Older People in Canadian Emergency Departments
Community
Regional Geriatric Program of Toronto: Guidance on Delirium Care for Older Adults in the Community