SynthesisInternational journal of environmental research and public health2020
Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis.
Synthesis in International journal of environmental research and public health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.
What it found
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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.
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.
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Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Prevalence of delirium among older nursing home residents: a systematic review and meta-analysis.European geriatric medicine · 2026Pooled it
- Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2024Pooled it
- Diagnostic performance of radiomics in adrenal masses: A systematic review and meta-analysis.Frontiers in oncology · 2022Pooled it
- Early Diagnosis of Delirium in Geriatric Patients in Emergency Departments: A Systematic Review and Meta-Analysis.Brain sciences · 2026Review
- Targeted Delirium Screening in At-risk Older Adults in the Emergency Department Improves Screening Rates.Journal of the American College of Emergency Physicians open · 2026Article
- Prevalence of delirium in German nursing homes: A cross-sectional study.BMC geriatrics · 2026Article
- Recruiting People With Dementia in Emergency Research: Insights From Geriatric Emergency Care Applied Research 2.0 Network (GEAR 2.0) Pilot Studies.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2026Article
- Translation, Cultural Adaptation, and Validation of the Greek Version of the 4 'A's Test for Delirium Screening in Elderly Patients with Hip Fracture.Clinics and practice · 2026Article
- Article
- Older Patients' Postoperative Neurocognitive Recovery: A Narrative Review.Clinical interventions in aging · 2025Review
- [Risk of postoperative delirium in older adults under balanced general anesthesia].Revista medica del Instituto Mexicano del Seguro Social · 2024Article
- Delirium in nursing home residents: is there a role of antidepressants? A cross sectional study.BMC geriatrics · 2024Article
- The 4AT scale for rapid detection of delirium in emergency department triage.Frontiers in medicine · 2024Article
- Article
- Exploring the Association between Delirium and Malnutrition in COVID-19 Survivors: A Geriatric Perspective.Nutrients · 2023Article
- Diagnostic accuracy of the Dutch version of the 4AT for delirium detection in a mixed patient population and setting.Aging clinical and experimental research · 2023Observational
- Detecting delirium: a systematic review of ultrabrief identification instruments for hospital patients.Frontiers in psychology · 2023Review
- Review
- The Use of Psychotropic Medication in Pediatric Oncology for Acute Psychological and Psychiatric Problems: Balancing Risks and Benefits.Children (Basel, Switzerland) · 2022Review
- Diagnostic test accuracy of assessment tools for detecting delirium in patients with acute stroke: commentary of a systematic review.British journal of neuroscience nursing · 2022Article
Corrections and comments
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Under-recognition of delirium is an international problem. For the early detection of delirium, a feasible and valid screening tool for healthcare professionals is needed. This study aimed to present a scientific reason for using the 4 'A's Test (4AT) through a systematic review and meta-analysis of studies on the diagnostic test accuracy. We systematically searched articles in the EMBASE, MEDLINE, CINAHL, and PsycINFO databases and selected relevant articles on the basis of the predefined inclusion criteria. The quality of the included articles was evaluated using the Quality Assessment of the Diagnostic Accuracy Studies-2 tool. We estimated the pooled values of diagnostic test accuracy by employing the bivariate model and the hierarchical summary receiver operating characteristic (HSROC) model in data synthesis. A total of 3729 patients of 13 studies were included in the analysis. The pooled estimates of sensitivity and specificity of the 4AT were 81.5% (95% confidence interval: 70.7%, 89.0%) and 87.5% (79.5%, 92.7%), respectively. Given the 4AT's evidence of accuracy and practicality, we suggest healthcare professionals to utilize this tool for routine screening of delirium. However, for detecting delirium in the dementia population, further work is required to evaluate the 4AT with other cut-off points or scoring methods in order for it to be more sensitive and specific.
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