4AT validation study
Research type
Research Study
Full title
The 4AT as a triage test for delirium: a validation study in acutely hospitalised older patients
IRAS ID
180829
Contact name
Alasdair MacLullich
Contact email
ISRCTN Number
ISRCTN53388093
Clinicaltrials.gov Identifier
Scotland A REC reference, 15/SS/0071
Duration of Study in the UK
1 years, 7 months, 20 days
Research summary
Delirium is a severe acute deterioration in mental functioning, mostly brought on by acute illness or the side effects of drugs. In contrast to dementia, delirium emerges rapidly, over hours or days. Older people are particularly prone to developing delirium.
Delirium affects at least 1 in 5 older people admitted as an emergency. Delirium is serious, being linked with increased mortality rates, longer hospital stay, and new admission to a nursing home. Delirium can also be highly distressing to patients and their carers.
However, more than 70% of delirium is undiagnosed. This is partly because of the lack of practical bedside tests for delirium.
Here we will study a new 2 minute test for delirium called the 4AT (www.the4AT.com). The 4AT assesses level of alertness, cognition (orientation and attention), and presence of an acute change in mental status. The 4AT is already in use in many clinical units. However, large validation studies, essential to test the 4AT thoroughly, are still lacking.
We will recruit 900 people aged 70 or over from wards and emergency departments. We will compare performance on the 4AT with a reference standard delirium assessment and also with another test for delirium called the Confusion Assessment Method, which is already used clinically but which takes longer to complete and needs more training than the 4AT. Participants will undergo either the 4AT or the CAM, and also a detailed reference standard assessment. We will also ask an appropriate informant to complete a questionnaire on longer-term change in memory and thinking in the patient. Finally, a resource use questionnaire will also be administered 12 weeks after recruitment.
This study will provide a definitive assessment of the performance of the 4AT as a rapid, practical tool for the detection of delirium in acute clinical settings.
REC name
Yorkshire & The Humber - Bradford Leeds Research Ethics Committee
REC reference
15/YH/0317
Date of REC Opinion
22 Sep 2015
REC opinion
Further Information Favourable Opinion