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

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dc.contributor.author Tieges, Zoë
dc.contributor.author MacLullich, Alasdair M.
dc.contributor.author Anand, Atul
dc.contributor.author Brookes, Claire
dc.contributor.author Cassarino, Marica
dc.contributor.author O'Connor, Margaret
dc.contributor.author Ryan, Damien
dc.contributor.author Saller, Thomas
dc.contributor.author Arora, Rakesh C.
dc.contributor.author Chang, Yue
dc.contributor.author Agarwal, Kathryn
dc.contributor.author Taffet, George
dc.contributor.author Quinn, Terence
dc.contributor.author Shenkin, Susan D.
dc.contributor.author Galvin, Rose
dc.date.accessioned 2021-07-23T09:02:13Z
dc.date.available 2021-07-23T09:02:13Z
dc.date.issued 2021
dc.identifier.uri http://hdl.handle.net/10344/10401
dc.description peer-reviewed en_US
dc.description.abstract Objective: 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. Methods: 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. Results: 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 10.5–61.9%). The pooled sensitivity was 0.88 (95% CI 0.80–0.93) and the pooled specificity was 0.88 (95% CI 0.82–0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77–0.92) and the pooled specificity was 0.89 (95% CI 0.83–0.93). The methodological quality of studies varied but was moderate to good overall. Conclusions: The 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection. en_US
dc.language.iso eng en_US
dc.publisher Oxford University Press en_US
dc.relation.ispartofseries Age and Ageing;50, pp. 733-743
dc.subject delirium en_US
dc.subject older adults en_US
dc.title Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis en_US
dc.type info:eu-repo/semantics/article en_US
dc.type.supercollection all_ul_research en_US
dc.type.supercollection ul_published_reviewed en_US
dc.identifier.doi 10.1093/ageing/afaa224
dc.contributor.sponsor Wellcome Trust-University of Edinburgh en_US
dc.relation.projectid IS3-T06/03 en_US
dc.rights.accessrights info:eu-repo/semantics/openAccess en_US


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