Observational studyAge and ageing2025
Validation of the 4AT for assessing recovery from delirium in older hospital patients.
Observational study in Age and ageing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 3 papers.
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.
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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
3 citing papers in PubMed.
- Evaluation of a Multidimensional Occupational Therapy Environmental Checklist for People Experiencing Delirium During Hospital Admission: A Quasi-Experimental Study.Australasian journal on ageing · 2026Article
- 'Just a delirium': a qualitative study of care home managers' perspectives on barriers to delirium recognition and management in UK care homes.Age and ageing · 2026Article
- Article
Corrections and comments
- Erratum issued
Authors and funding
12 authors.
Funding
Abstract
backgroundA crucial part of delirium care is assessing for recovery, yet there are no validated methods for this. The 4AT is a widely used delirium assessment tool, but its performance in assessing recovery remains unstudied. This study evaluated the 4AT's performance in assessing recovery from delirium. MATERIALS AND
methodsIn this prospective diagnostic accuracy study, older hospitalised patients (≥70 years) with reference standard delirium on enrolment were assessed 2-4 times over ≤9 days. Paired researchers independently conducted blinded assessments of (i) a reference standard (Diagnostic and Statistical Manual for Mental Disorders, 5th edition), including the Delirium Rating Scale-Revised-98 and neuropsychological tests and (ii) the 4AT (index test, score ≥ 4 positive) plus brief measures of distress and psychotic symptoms.
resultsA total of 120 people with delirium participated [median age 86.3, range 70-99, 67 (55.8%) female and 55 (45.8%) with dementia]. All of them completed the first two assessments, 103 (85.8%) completed three and 69 (57.5%) four. Reference standard delirium was present in 102/120 (85%), 72/103 (69.9%) and 53/69 (76.8%) cases at assessments two to four, respectively. In Receiver Operating Characteristic analyses, the 4AT's sensitivity for detecting delirium was 0.95 (confidence interval 0.91-0.99), 0.96 (0.91-1) and 0.94 (0.88-1), and specificity was 0.67 (0.13-1), 0.88 (0.71-1) and 1 (1-1) at assessments two to four. In total 18 (15%) participants recovered from delirium. Distress was common in delirium and decreased with recovery.
conclusionThe 4AT maintains diagnostic accuracy on repeated admissions and may effectively assess delirium recovery in acute hospital settings. Fewer patients than expected recovered within 9 days, suggesting more studies on the natural history of delirium in different settings would be informative.
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