REFERENCES

selected 4at validation & implementation studies, & REVIEWS

Morales-Puerto M, Ruiz-Díaz M, García-Mayor S, León-Campos Á, Morales-Asencio JM, Canca-Sánchez JC, Gavira-Guerra S, Toledo-Fernandez C, Aranda-Gallardo M. Spanish transcultural adaptation of the 4AT score for the evaluation of delirium in the emergency department: a prospective diagnostic test accuracy study. BMC Nurs. 2024 Feb 6;23(1):101. doi: 10.1186/s12912-023-01638-6.

Penfold RS, Squires C, Angus A, Shenkin SD, Ibitoye T, Tieges Z, Neufeld KJ, Avelino-Silva TJ, Davis D, Anand A, Duckworth AD, Guthrie B, MacLullich AMJ. Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review. J Am Geriatr Soc. 2024 Jan 19. doi: 10.1111/jgs.18751.

Penfold RS, Hall AJ, Anand A, Clement ND, Duckworth AD, MacLullich AMJ. Delirium in hip fracture patients admitted from home during the COVID-19 pandemic is associated with higher mortality, longer total length of stay, need for post-acute inpatient rehabilitation, and readmission to acute services. Bone Jt Open. 2023 Jun 16;4(6):447-456.

Hawley S, Inman D, Gregson CL, Whitehouse M, Johansen A, Judge A. Risk Factors and 120-Day Functional Outcomes of Delirium After Hip Fracture Surgery: A Prospective Cohort Study Using the UK National Hip Fracture Database (NHFD). J Am Med Dir Assoc. 2023 May;24(5):694-701.e7.

Anand A, Cheng M, Ibitoye T, Maclullich AMJ, Vardy ERLC. Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions. Age and Ageing. 2022 51 (3).

Cullum S, Kubba Y, Varghese C, Coomarasamy C, Hopkins J. The evidence for introducing case-finding for delirium and dementia in older medical inpatients in a New Zealand hospital. Australas Psychiatry. 2022 Jan 3:10398562211062465.

Aldwikat RK, Manias E, Tomlinson E, Amin M, Nicholson P. Delirium screening tools in the post-anaesthetic care unit: a systematic review and meta-analysis. Aging Clin Exp Res. 2022 Jan 3.

Alhaidari AAO, Matsis KP. Barriers to completing the 4AT for delirium and its clinical implementation in two hospitals: a mixed-methods study. Eur Geriatr Med. 2021 Nov 16.

Hasegawa T, Seo T, Kubota Y, Sudo T, Yokota K, Miyazaki N, Muranaka N, Hirano S, Yamauchi A, Nagashima K, Iyo M, Sakai I. Reliability and validity of the Japanese version of the 4A's Test for delirium screening in the elderly patient. Asian Journal of Psychiatry, 2021, 102918.

Johansson YA, Tsevis T, Nasic S, Gillsjö C, Johansson L, Bogdanovic N, Kenne Sarenmalm E. Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting. BMC Geriatr. 2021 Oct 18;21(1):568.

Evensen S, Hylen Ranhoff A, Lydersen S, Saltvedt I. The delirium screening tool 4AT in routine clinical practice: prediction of mortality, sensitivity and specificity. Eur Geriatr Med. 2021 Aug;12(4):793-800.

Chang Y, Ragheb SM, Oravec N, Kent D, Nugent K, Cornick A, Hiebert B, Rudolph JL, MacLullich AMJ, Arora RC. Diagnostic accuracy of the "4 A's Test" delirium screening tool for the postoperative cardiac surgery ward. J Thorac Cardiovasc Surg. 2021 Jun 1:S0022-5223(21)00876-X.

Tieges Z, Lowrey J, MacLullich AMJ. What delirium detection tools are used in routine clinical practice in the United Kingdom? Survey results from 91% of acute healthcare organisations. Eur Geriatr Med. 2021 May 18.

Tieges Z, MacLullich AMJ, Anand A, Brookes C, Cassarino M, O'connor M, Ryan D, Saller T, Arora RC, Chang Y, Agarwal K, Taffet G, Quinn T, Shenkin SD, Galvin R. Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis. Age Ageing. 2021 May 5;50(3):733-743.

Bridwell RE, April MD, Long B. Is the 4AT Score Accurate in Identifying Delirium in Older Adults? Ann Emerg Med. 2021 Jun;77(6):628-630.

Jeong E, Park J, Lee J. Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health. 2020 Oct 15;17(20):7515.

Calf AH, Pouw MA, van Munster BC, Burgerhof JGM, de Rooij SE, Smidt N. Screening instruments for cognitive impairment in older patients in the Emergency Department: a systematic review and meta-analysis. Age Ageing. 2021 Jan 8;50(1):105-112.

Saller T, MacLullich AMJ, Perneczky R. The 4AT - an instrument for delirium detection for older patients in the post-anaesthesia care unit. Anaesthesia. 2020 Mar;75(3):410.

Mansutti I, Saiani L, Palese A. Detecting delirium in patients with acute stroke: a systematic review of test accuracy. BMC Neurol. 2019;19(1):310. Published 2019 Dec 2.

Shenkin SD, Fox C, Godfrey M, Siddiqi N, Goodacre S, Young J, Anand A, Gray A, Hanley J, MacRaild A, Steven J, Black PL, Tieges Z, Boyd J, Stephen J, Weir CJ, MacLullich AMJ. Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the Confusion Assessment Method. BMC Med. 2019 Jul 24;17(1):138

Saller T, MacLullich AMJ, Schäfer ST, Crispin A, Neitzert R, Schüle C, von Dossow V, Hofmann-Kiefer KF. Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post-anaesthesia care unit. Anaesthesia. 2019;74:1260-1266

Gagné AJ, Voyer P, Boucher V, Nadeau A, Carmichael PH, Pelletier M, Gouin E, Berthelot S, Daoust R, Wilchesky M, Richard H, Pelletier I, Ballard S, Laguë A, Émond M. Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department. CJEM. 2018 Nov;20:903-910

O'Sullivan D, Brady N, Manning E, O'Shea E, O'Grady S, O 'Regan N, Timmons S. Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees. Age Ageing. 2018; 47:61-68

Baird L, Spiller JA. A quality improvement approach to cognitive assessment on hospice admission: could we use the 4AT or Short CAM? BMJ Open Qual. 2017; 6(2):e000153

Infante MT, Pardini M, Balestrino M, Finocchi C, Malfatto L, Bellelli G, Mancardi GL, Gandolfo C, Serrati C. Delirium in the acute phase after stroke: comparison between methods of detection. Neurol Sci. 2017; 386:1101-1104

De J, Wand AP, Smerdely PI, Hunt GE. Validating the 4A's test in screening for delirium in a culturally diverse geriatric inpatient population. Int J Geriatr Psychiatry. 2017; 32:1322-1329

Hendry K, Quinn TJ, Evans J, Scortichini V, Miller H, Burns J, Cunnington A, Stott DJ. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age Ageing. 2016; 45:832-837

Kuladee S, Prachason T. Development and validation of the Thai version of the 4 'A's Test for delirium screening in hospitalized elderly patients with acute medical illnesses. Neuropsychiatr Dis Treat. 2016; 12:437-43

Bellelli G, Morandi A, Davis DH, Mazzola P, Turco R, Gentile S, Ryan T, Cash H, Guerini F, Torpilliesi T, Del Santo F, Trabucchi M, Annoni G, MacLullich AM. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing. 2014; 43:496-502

Lees R, Corbet S, Johnston C, Moffitt E, Shaw G, Quinn TJ. Test accuracy of short screening tests for diagnosis of delirium or cognitive impairment in an acute stroke unit setting. Stroke. 2013; 44:3078-83

SELECTED studies using the 4AT

Matharu GS, Shah A, Hawley S, Johansen A, Inman D, Moppett I, Whitehouse MR, Judge A. The influence of mode of anaesthesia on perioperative outcomes in people with hip fracture: a prospective cohort study from the National Hip Fracture Database for England, Wales and Northern Ireland. BMC Med. 2022 Sep 26;20(1):319. doi: 10.1186/s12916-022-02517-8.

Myrstad M, Kuwelker K, Haakonsen S, Valebjørg T, Langeland N, Kittang BR, Hagberg G, Neerland BE, Bakken MS. Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis: a prospective cohort study. Eur Geriatr Med. 2021 Oct 8.

O'Shaughnessy Í, Romero-Ortuno R, Edge L, Dillon A, Flynn S, Briggs R, Shields D, McMahon G, Hennessy A, Kennedy U, Staunton P, McNamara R, Timmons S, Horgan F, Cunningham C. Home FIRsT: interdisciplinary geriatric assessment and disposition outcomes in the Emergency Department. Eur J Intern Med. 2020 Nov 23:S0953-6205(20)30425-8.

Vardy E, Collins N, Grover U, et al. Use of a digital delirium pathway and quality improvement to improve delirium detection in the emergency department and outcomes in an acute hospital. Age Ageing. 2020;49(4):672-678.

Lisk R, Yeong K, Enwere P, Jenkinson J, Robin J, Irvin-Sellers M, Fluck D, Osmani A, Sharmin R, Sharma P, Fry CH, Han TS. Associations of 4AT with mobility, length of stay and mortality in hospital and discharge destination among patients admitted with hip fractures. Age Ageing. 2020 Apr 27;49(3):411-417.

Dormandy L, Mufti S, Higgins E, Bailey C, Dixon M. Shifting the focus: A QI project to improve the management of delirium in patients with hip fracture. Future Healthc J. 2019;6:215-219

Mossello E, Tesi F, Di Santo SG, Mazzone A, Torrini M, Cherubini A, Bo M, Musicco M, Bianchetti A, Ferrari A, Ferrara N, Trabucchi M, Morandi A, Bellelli G; Italian Study Group on Delirium. Recognition of Delirium Features in Clinical Practice: Data from the "Delirium Day 2015" National Survey. J Am Geriatr Soc. 2018;66:302-308

Bauernfreund Y, Butler M, Ragavan S, Sampson EL. TIME to think about delirium: improving detection and management on the acute medical unit. BMJ Open Qual. 2018 Aug 13;7(3):e000200

Morandi A, Di Santo SG, Cherubini A, Mossello E, Meagher D, Mazzone A, Bianchetti A, Ferrara N, Ferrari A, Musicco M, Trabucchi M, Bellelli G; ISGoD Group. Clinical Features Associated with Delirium Motor Subtypes in Older Inpatients: Results of a Multicenter Study. Am J Geriatr Psychiatry. 2017; 25:1064-1071.

Bellelli G, Morandi A, Di Santo SG, Mazzone A, Cherubini A, Mossello E, Bo M, Bianchetti A, Rozzini R, Zanetti E, Musicco M, Ferrari A, Ferrara N, Trabucchi M; Italian Study Group on Delirium (ISGoD). "Delirium Day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool. BMC Med. 2016; 14:106

Morandi A, Han JH, Meagher D, Vasilevskis E, Cerejeira J, Hasemann W, MacLullich AM, Annoni G, Trabucchi M, Bellelli G. Detecting Delirium Superimposed on Dementia: Evaluation of the Diagnostic Performance of the Richmond Agitation and Sedation Scale. J Am Med Dir Assoc. 2016; 17:828-33

selected LITERATURE relevant to the 4AT

GENERAL

Rieck KM, Pagali S, Miller DM. Delirium in hospitalized older adults. Hosp Pract. 2020 Mar;48(sup1):3-16

Davis D, Searle SD, Tsui A. The Scottish Intercollegiate Guidelines Network: risk reduction and management of delirium. Age Ageing. 2019;48:485-488

Bearn A, Lea W, Kusznir J. Improving the identification of patients with delirium using the 4AT assessment. Nurs Older People. 2018;30:18-27

Oliver D. Delirium matters. BMJ. 2016;353:i2886

De J, Wand AP. Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients. Gerontologist. 2015; 55:1079-99

Shenkin SD, Russ TC, Ryan TM, MacLullich AM. Screening for dementia and other causes of cognitive impairment in general hospital in-patients. Age Ageing. 2014; 43:166-8

Level of alertness/arousal component

Tieges Z, Quinn T, MacKenzie L, Davis D, Muniz-Terrera G, MacLullich AMJ, Shenkin SD. Association between components of the delirium syndrome and outcomes in hospitalised adults: a systematic review and meta-analysis. BMC Geriatr. 2021 Mar 5;21(1):162.

Richardson SJ, Davis DHJ, Bellelli G, Hasemann W, Meagher D, Kreisel SH, MacLullich AMJ, Cerejeira J, Morandi A. Detecting delirium superimposed on dementia: diagnostic accuracy of a simple combined arousal and attention testing procedure. Int Psychogeriatr. 2017; 29:1585-1593

Han JH, Brummel NE, Chandrasekhar R, Wilson JE, Liu X, Vasilevskis EE, Girard TD, Carlo ME, Dittus RS, Schnelle JF, Ely EW. Exploring Delirium's Heterogeneity: Association Between Arousal Subtypes at Initial Presentation and 6-Month Mortality in Older Emergency Department Patients. Am J Geriatr Psychiatry. 2017; 25:233-242

Grossmann FF, Hasemann W, Kressig RW, Bingisser R, Nickel CH. Performance of the modified Richmond Agitation Sedation Scale in identifying delirium in older ED patients. Am J Emerg Med. 2017;35(9):1324-1326.

Rudolph JL. Arousal, Attention, and an Abundance of Opportunity to Advance Delirium Care. J Am Med Dir Assoc. 2016; 17:775-6

Morandi A, Han JH, Meagher D, et al. Detecting Delirium Superimposed on Dementia: Evaluation of the Diagnostic Performance of the Richmond Agitation and Sedation Scale. J Am Med Dir Assoc. 2016;17(9):828-833.

Bellelli G, Mazzone A, Morandi A, Latronico N, Perego S, Zazzetta S, Mazzola P, Annoni G. The Effect of an Impaired Arousal on Short- and Long-Term Mortality of Elderly Patients Admitted to an Acute Geriatric Unit. J Am Med Dir Assoc. 2016; 17:214-9

Han JH, Vasilevskis EE, Schnelle JF, et al. The Diagnostic Performance of the Richmond Agitation Sedation Scale for Detecting Delirium in Older Emergency Department Patients. Acad Emerg Med. 2015;22(7):878-882.

Han JH, Vasilevskis EE, Shintani A, Graves AJ, Schnelle JF, Dittus RS, Powers JS, Wilson A, Storrow AB, Ely EW. Impaired arousal at initial presentation predicts 6-month mortality: An analysis of 1084 acutely ill older patients. J Hosp Med. 2014; 9:772-8

Tieges Z, McGrath A, Hall RJ, MacLullich AM. Abnormal level of arousal as a predictor of delirium and inattention: an exploratory study. Am J Geriatr Psychiatry. 2013; 21:1244-53

Chester JG, Beth Harrington M, Rudolph JL; VA Delirium Working Group. Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening. J Hosp Med. 2012; 7:450-3

AMT4 component

Lindsay WA, Moppett IK. Interchangeability of AMT4 and AMTS in a hip fracture population. Anaesthesia. 2019;74(11):1477-1478.

Carpenter CR, Banerjee J, Keyes D, et al. Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta-analysis. Acad Emerg Med. 2019;26(2):226-245.

Schofield I, Stott DJ, Tolson D, McFadyen A, Monaghan J, Nelson D. Screening for cognitive impairment in older people attending accident and emergency using the 4-item Abbreviated Mental Test. Eur J Emerg Med. 2010; 17:340-2

Swain DG, Nightingale PG. Evaluation of a shortened version of the Abbreviated Mental Test in a series of elderly patients. Clin Rehabil. 1997; 11:243-8

Months Backwards component

Hasemann W, Duncan N, Clarke C, Nouzova E, Süßenbach LM, Keerie C, Assi V, Weir CJ, Evans J, Walsh T, Wilson E, Quasim T, Middleton D, Weir AJ, Barnett JH, Stott DJ, MacLullich AMJ, Tieges Z. Comparing performance on the Months of the Year Backwards test in hospitalised patients with delirium, dementia, and no cognitive impairment: an exploratory study. Eur Geriatr Med. 2021 Jun 22.

O'Regan NA, Maughan K, Liddy N, Fitzgerald J, Adamis D, Molloy DW, Meagher D, Timmons S. Five short screening tests in the detection of prevalent delirium: diagnostic accuracy and performance in different neurocognitive subgroups. Int J Geriatr Psychiatry. 2016 Dec 5. [Epub ahead of print]

Meagher J, Leonard M, Donoghue L, O'Regan N, Timmons S, Exton C, Cullen W, Dunne C, Adamis D, Maclullich A, Meagher D. Months backward test: A review of its use in clinical studies. World J Psychiatry. 2015; 5:305-14

O'Regan NA, Ryan DJ, Boland E, Connolly W, McGlade C, Leonard M, Clare J, Eustace JA, Meagher D, Timmons S. Attention! A good bedside test for delirium? J Neurol Neurosurg Psychiatry. 2014; 85:1122-31