Delirium detection in hospitalized adults: the performance of the 4 'A's Test and the modified Confusion Assessment Method for the Emergency Department. A comparison study

Abstract

Background

Early detection of delirium through systematic screening is essential to mitigate and prevent possible consequences. The 4 'A's Test (4AT) is a new tool that can be used for delirium detection easily and without special training. The modified Confusion Assessment Method for Emergency Department (mCAM-ED) is an operationalized version of the Confusion Assessment Method, a worldwide used tool for delirium screening in clinical practice and research. This is the first comparison of both delirium screening tools. This study aimed to investigate performance accuracy of the 4AT compared to the mCAM-ED in detecting delirium in hospitalized patients.

Methods

In this prospective single-centre cross-sectional pilot study, patients from six wards were selected consecutively. All patients underwent a delirium screening with the gold standard, the mCAM-ED. To rate the algorithm of the 4AT, corresponding items of the mCAM-ED were derived and used.

Results

A total of 116 patients with a median age of 73 years could be included. Dementia was present in 11 (9.5%) patients, and 42.2% were women. Delirium was present in 8/116 (6.9%) and 16/116 (13.8%) patients according to the mCAM-ED and the 4AT, respectively. In comparison, the 4AT showed 100% (95% CI 0.63, 1.00) sensitivity, 93% (95% CI 0.86, 0.97) specificity, 13.50 (95% CI 6.93, 26.30) positive likelihood ratio and 0.00 (95% CI 0.00, NaN) negative likelihood ratio.

Conclusions

In this first comparison, the 4AT showed a high rate of false-positive scores, which may result in an increased need for further in-depth assessments.