Evidence map›Paper›PMID 31337404›Full record

Trial reportBMC medicine2019

Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method.

Susan D Shenkin, Christopher Fox, Mary Godfrey, Najma Siddiqi, Steve Goodacre, John Young, Atul Anand, Alasdair Gray, Janet Hanley, Allan MacRaild and 7 more

Registry-linked trialOpen access · goldAbstract readComparative StudyMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04962815 (Ceribell Delirium Data Collection Study), which is not on this map. Cited by 86 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
86citing papers in PubMed, 7 pooled it
17.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04962815 recruitingnot on this mapstarted 2021, after this paper: background citation

Ceribell Delirium Data Collection Study

Typeobservational_patient_registrySponsorCeribell Inc.Ran2021 to 2026Enrolled200ConditionsDeliriumArmsElectroencephalogram (EEG) Test
3 · Its place in the literature

Who cites it

86 citing papers in PubMed, 7 syntheses or guidelines pooled it, 205 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis.International journal of environmental research and public health · 2020
    Pooled it
  7. Pooled it
  8. Trial
  9. Trial
  10. Trial
  11. Article
  12. Observational
  13. Review
  14. Article
  15. Article
  16. Article
  17. Article
  18. Article
  19. Article
  20. Article

26 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

17 authors at 8 institutions in 1 country.

Susan D ShenkinGeriatric Medicine, Edinburgh Delirium Research Group, Royal Infirmary of Edinburgh, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh 51, Little France Crescent, Edinburgh, EH16 4SA, UK.
Christopher FoxNorwich Medical School, University of East Anglia, Norfolk, UK.
Mary GodfreyElderly Care and Rehabilitation and Institute of Health Sciences, University of Leeds, Leeds, UK.
Najma SiddiqiDepartment of Health Sciences, University of York, Hull York Medical School, Bradford District Care NHS Foundation Trust, Bradford, UK.
Steve GoodacreSchool of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
John YoungAcademic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK.
Atul AnandCardiovascular Sciences and Geriatric Medicine, University of Edinburgh, Edinburgh, UK.
Alasdair GrayEmergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK.
Janet HanleyHealth and Social Care, Edinburgh Napier University, Edinburgh, UK.
Allan MacRaildEmergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK.
Jill StevenEmergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK.
Polly L BlackEmergency Medicine Research Group (EMERGE), NHS Lothian, Edinburgh, UK.
Zoë TiegesGeriatric Medicine, Edinburgh Delirium Research Group, Royal Infirmary of Edinburgh, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh 51, Little France Crescent, Edinburgh, EH16 4SA, UK.
Julia BoydEdinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Jacqueline StephenEdinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Christopher J WeirEdinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
Alasdair M J MacLullichGeriatric Medicine, Edinburgh Delirium Research Group, Royal Infirmary of Edinburgh, University of Edinburgh, Room S1642, Royal Infirmary of Edinburgh 51, Little France Crescent, Edinburgh, EH16 4SA, UK. a.maclullich@ed.ac.uk.ORCID 0000-0003-3159-9370
NHS Lothian · GBUniversity of Edinburgh · GBEdinburgh Royal Infirmary · GBUniversity of Leeds · GBBradford District Care NHS Foundation Trust · GBEdinburgh Napier University · GBUniversity of East Anglia · GBUniversity of Sheffield · GB

Funding

Department of Health PB-PG-0610-22068
6 · The paper itself

Abstract

backgroundDelirium affects > 15% of hospitalised patients but is grossly underdetected, contributing to poor care. The 4 'A's Test (4AT, www.the4AT.com ) is a short delirium assessment tool designed for routine use without special training. The primary objective was to assess the accuracy of the 4AT for delirium detection. The secondary objective was to compare the 4AT with another commonly used delirium assessment tool, the Confusion Assessment Method (CAM).

methodsThis was a prospective diagnostic test accuracy study set in emergency departments or acute medical wards involving acute medical patients aged ≥ 70. All those without acutely life-threatening illness or coma were eligible. Patients underwent (1) reference standard delirium assessment based on DSM-IV criteria and (2) were randomised to either the index test (4AT, scores 0-12; prespecified score of > 3 considered positive) or the comparator (CAM; scored positive or negative), in a random order, using computer-generated pseudo-random numbers, stratified by study site, with block allocation. Reference standard and 4AT or CAM assessments were performed by pairs of independent raters blinded to the results of the other assessment.

resultsEight hundred forty-three individuals were randomised: 21 withdrew, 3 lost contact, 32 indeterminate diagnosis, 2 missing outcome, and 785 were included in the analysis. Mean age was 81.4 (SD 6.4) years. 12.1% (95/785) had delirium by reference standard assessment, 14.3% (56/392) by 4AT, and 4.7% (18/384) by CAM. The 4AT had an area under the receiver operating characteristic curve of 0.90 (95% CI 0.84-0.96). The 4AT had a sensitivity of 76% (95% CI 61-87%) and a specificity of 94% (95% CI 92-97%). The CAM had a sensitivity of 40% (95% CI 26-57%) and a specificity of 100% (95% CI 98-100%).

conclusionsThe 4AT is a short, pragmatic tool which can help improving detection rates of delirium in routine clinical care.

trial registrationInternational standard randomised controlled trial number (ISRCTN) 53388093 . Date applied 30/05/2014; date assigned 02/06/2014.

Indexed as

Diagnostic Tests, RoutineNeuropsychological TestsAcute DiseaseAgedAged, 80 and overAlgorithmsChecklistConfusionDeliriumDiagnostic and Statistical Manual of Mental DisordersEmergency Service, HospitalFemaleGeriatric AssessmentHumansInpatientsMale4ATConfusion assessment method (CAM)DeliriumDiagnostic test accuracyHospitalSensitivitySpecificity

Identifiers

PMID31337404
PMCPMC6651960
OpenAlexW2949453524

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.