4As_test v.1
The 4A's Test is used to screen for delirium in older patients. According to the result of a set of questions to the patient, a total score and an interpretation of the cognitive impairment is generated.
To diagnose delirium in older patients.
Evaluate the mental state of a patient according to the four A's: Alertness - May ask patient to state name and address to help with rating AMT4 - Age, date of birth, place (name of the hospital or building), current year Attention - Instruct patient to list months in reverse order, starting at December Acute change or fluctuating course - Evidence of significant change or fluctuation in mental status within the last 2 weeks and still persisting in the last 24 hours Each of the four A's correspond to a set of scores. The total 4AT Score is recieved by adding the subscores. An interpretation of the level of impairment is then provided according to: 4AT Score Level of impairment ≥4 Possible delirium and/or cognitive impairment 1–3 Possible cognitive impairment 0 Delirium or severe cognitive impairment unlikely (but delirium still possible if “acute change or fluctuating course” information is incomplete)
Not to be used for repeated daily monitoring for new onset delirium.
Shenkin, S.D., Fox, C., Godfrey, M. et al. 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 17, 138 (2019). Giuseppe Bellelli, Alessandro Morandi, Daniel H.J. Davis, Paolo Mazzola, Renato Turco, Simona Gentile, Tracy Ryan, Helen Cash, Fabio Guerini, Tiziana Torpilliesi, Francesco Del Santo, Marco Trabucchi, Giorgio Annoni, Alasdair M.J. MacLullich, Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people, Age and Ageing, Volume 43, Issue 4, July 2014, Pages 496–502
OBSERVATION.aaaa_test.v1, EVALUATION.aaaa_test_assessment.v0
