_id

683a161ac782e11e38d1b1ca

id

3982

title

4 A’s Test for Delirium Screening

full_title

4 A’s Test for Delirium Screening

short_title

4AT

med_description

Diagnoses delirium in older patients.

short_description

Delirium screening.

slug

4-test-delirium-assessment

description

The 4 A’s Test for Delirium Screening diagnoses delirium in older patients.

keywords

4at, amt, amt4, amt10, delirium, dementia

complaint

[ "Agitation", "AMS", "Anxious" ]

formula

Addition of the selected points: *Instruct patient to list months in reverse order, starting at December. **Evidence of significant change or fluctuation in mental status within the last 2 weeks and still persisting in the last 24 hours.

evidence

measurements

[]

information

Interpretation:

refrences

{ "Clinical Practice Guidelines": [], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://academic.oup.com/ageing/article/43/4/496/2812210/Validation-of-the-4AT-a-new-instrument-for-rapid ", "text": "Bellelli G, Morandi A, Davis DH, et al. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing. 2014;43(4):496-502." } ], "Other References": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/19917632 ", "text": "Collins N, Blanchard MR, Tookman A, Sampson EL. Detection of delirium in the acute hospital. Age Ageing. 2010;39(1):131-5." } ], "Outcomes": [], "Validation": [ { "href": "https://www.ncbi.nlm.nih.gov/pubmed/23988641 ", "text": "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(11):3078-83." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/26966365 ", "text": "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." }, { "href": "https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.4615", "text": "De J, Wand APF, 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(12):1322-1329." } ], "Validations": [] }

pearls

• Screens with higher sensitivity in patients without dementia.
• No consensus exists for the assessment of inattention.
• Limited external validation in some small populations, including the acute stroke setting.
• Validated in non-English speaking patients with 91% sensitivity (De 2016).

usecase

Patients admitted to geriatric wards, to screen for delirium.

reasons

Delirium is misdiagnosed, missed, or diagnosed late in over 60% of cases (Collins 2010). A simple screening tool can help identify these patients. Can be used in patients deemed “untestable” by other tests.

next_advice

If delirium is diagnosed, identify and treat underlying cause.

next_actions

next_management

diseases

[ "Delirium", "Dementia" ]

input_schema

[ { "conditionality": "", "default": 0, "label_en": "<p>Alertness</p>", "mdcalc_info_concept": null, "name": "alert", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Normal", "value": 0 }, { "label": "Mild sleepiness for <10 seconds after waking, then normal", "value": 0 }, { "label": "Clearly abnormal", "value": 4 } ], "show_points": true, "tips_en": "May ask patient to state name and address to help with rating", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p><calculator id=\"3995\">AMT 4</calculator></p>", "mdcalc_info_concept": null, "name": "amt", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No mistakes", "value": 0 }, { "label": "1 mistake", "value": 1 }, { "label": "≥2 mistakes or untestable", "value": 2 } ], "show_points": true, "tips_en": "Age, date of birth, place (name of the hospital or building), current year", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p>Attention</p>", "mdcalc_info_concept": null, "name": "atte", "option_fhir_rules": null, "optional": false, "options": [ { "label": "Lists ≥7 months correctly", "value": 0 }, { "label": "Starts but lists <7 months, or refuses to start", "value": 1 }, { "label": "Untestable (cannot start because unwell, drowsy, inattentive)", "value": 2 } ], "show_points": true, "tips_en": "Instruct patient to list months in reverse order, starting at December", "type": "radio" }, { "conditionality": "", "default": 0, "label_en": "<p>Acute change or fluctuating course</p>", "md_calc_info_concept": null, "name": "acute", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 4 } ], "show_points": true, "tips_en": "Evidence of significant change or fluctuation in mental status within the last 2 weeks and still persisting in the last 24 hours", "type": "toggle" } ]

instructions

published

2022-04-21T20:29:32.789Z

purpose

[ "Diagnosis" ]

search_terms

[ "4at", "4 A's Test", "4as test", "delirium screening", "4a delirium", "4as test", "4a test" ]

seo

{ "keywords_en": "4at, amt, amt4, amt10, delirium, dementia", "meta_description_en": "The 4 A’s Test for Delirium Screening diagnoses delirium in older patients." }

specialty

[ "Family Practice", "Geriatrics", "Primary Care" ]

departments

[ "Neurologic", "Psychiatric" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 3995, "short_title_en": "AMT-4", "slug": "abbreviated-mental-test-4-amt-4" }, { "calcId": 10208, "short_title_en": "AMT-10", "slug": "abbreviated-mental-test-amt-10" }, { "calcId": 10061, "short_title_en": "Ishihara Test", "slug": "color-vision-screening-ishihara-test" } ]

ismed

false

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "neurology", "psychiatry" ]

cleaned_use

[ "Patients admitted to geriatric wards, to screen for delirium." ]

pub

false