Evidence map›Paper›PMID 33951145›Full record

SynthesisAge and ageing2021

Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis.

Zoë Tieges, Alasdair M J Maclullich, Atul Anand, Claire Brookes, Marica Cassarino, Margaret O'connor, Damien Ryan, Thomas Saller, Rakesh C Arora, Yue Chang and 5 more

2 registry-linked trialsOpen access · hybridAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Age and ageing, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 126 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
126citing papers in PubMed, 4 pooled it
11.3field-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.

NCT05321771 naunknown statusnot on this map

The Effect of Involving a Family Caregiver in Promoting the Principles of the Hospital Elder Life Program on Decreasing Delirium Among Older Patients Hospitalized in the Orthopedic Unit Following Surgery for Post-fall Femoral Fracture.

TypeinterventionalSponsorRambam Health Care CampusRan2021 to 2025Enrolled50ConditionsDelirium, Femoral FractureArmsFamily caregiver application of HELP principles
NCT06687291 recruitingnot on this mapstarted 2025, after this paper: background citation

Cognitive Impact Associated With Surgery For Gastric Or Esophageal Cancer

Typeobservational_patient_registrySponsorKarolinska InstitutetRan2025 to 2028Enrolled130ConditionsGastroesophageal Cancer (GC), Postoperative Delirium (POD), Quality of Life (QOL), Frailty
3 · Its place in the literature

Who cites it

126 citing papers in PubMed, 4 syntheses or guidelines pooled it, 206 citations in OpenAlex.

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66 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

15 authors at 8 institutions in 5 countries.

Zoë TiegesGeriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.
Alasdair M J MaclullichGeriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.
Atul AnandGeriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.
Claire BrookesSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Marica CassarinoSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
Margaret O'connorDepartment of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland.
Damien RyanRetrieval, Emergency and Disaster Medicine Research and Development Unit (REDSPoT), Emergency Department, University Hospital Limerick, Limerick, Ireland.
Thomas SallerDepartment of Anaesthesiology, University Hospital, LMU Munich, Munich, Germany.
Rakesh C AroraDepartment of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Yue ChangDepartment of Surgery, Section of Cardiac Surgery, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
Kathryn AgarwalSection of Geriatrics, Baylor College of Medicine, Houston, TX, USA.
George TaffetSection of Geriatrics, Baylor College of Medicine, Houston, TX, USA.
Terence QuinnInstitute of Cardiovascular Medicine, University of Glasgow, Glasgow, Scotland, UK.
Susan D ShenkinGeriatric Medicine, Edinburgh Delirium Research Group, Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK.
Rose GalvinSchool of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland.
University of Edinburgh · GBUniversity of Limerick · IEMethodist Hospital · USUniversity Hospital Limerick · IELMU Klinikum · DESt. Boniface Hospital · CAUniversity of Glasgow · GBUniversity of Manitoba · CA

Funding

Wellcome Trust
6 · The paper itself

Abstract

objectiveDetection of delirium in hospitalised older adults is recommended in national and international guidelines. The 4 'A's Test (4AT) is a short (<2 minutes) instrument for delirium detection that is used internationally as a standard tool in clinical practice. We performed a systematic review and meta-analysis of diagnostic test accuracy of the 4AT for delirium detection.

methodsWe searched MEDLINE, EMBASE, PsycINFO, CINAHL, clinicaltrials.gov and the Cochrane Central Register of Controlled Trials, from 2011 (year of 4AT release on the website www.the4AT.com) until 21 December 2019. Inclusion criteria were: older adults (≥65 years); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity were generated from a bivariate random effects model.

resultsSeventeen studies (3,702 observations) were included. Settings were acute medicine, surgery, a care home and the emergency department. Three studies assessed performance of the 4AT in stroke. The overall prevalence of delirium was 24.2% (95% CI 17.8-32.1%; range 10.5-61.9%). The pooled sensitivity was 0.88 (95% CI 0.80-0.93) and the pooled specificity was 0.88 (95% CI 0.82-0.92). Excluding the stroke studies, the pooled sensitivity was 0.86 (95% CI 0.77-0.92) and the pooled specificity was 0.89 (95% CI 0.83-0.93). The methodological quality of studies varied but was moderate to good overall.

conclusionsThe 4AT shows good diagnostic test accuracy for delirium in the 17 available studies. These findings support its use in routine clinical practice in delirium detection. PROSPERO REGISTRATION NUMBER: CRD42019133702.

Indexed as

DeliriumAgedEmergency Service, HospitalGeriatric AssessmentHumansMass ScreeningSensitivity and Specificity4ATdeliriumdementiaolder patientsscreening toolsystematic review

Identifiers

PMID33951145
PMCPMC8099016
OpenAlexW3087620222

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.