Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department
Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department
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DOI：
10.1017/cem.2018.367
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发表时间：
2018-11-01
影响因子：
2.4
通讯作者：
Emond, Marcel
中科院分区：
文献类型：
--
作者：
Gagne, Anne-Julie;Voyer, Philippe;Emond, Marcel
目的：妄想在急诊科就诊的老年患者中非常常见，但通常未被发现。本研究的目的是评估法语版的4A测验(4AT-F)在检测老年患者的神志不清和认知障碍方面的表现。参与者(n=320)是65岁及以上的独立或半独立患者(能够进行5项日常生活活动)，并在ED环境中暴露8小时。在最初的访谈中，对患者进行了认知状态电话访谈(TICS-m)、困惑评估方法(CAM)以及4AT-F。然后，在患者急救或住院期间，每天两次使用CAM和4AT-F。结果：4AT-F对精神分裂症的敏感度为84%(95%CI：[76，93])，特异度为74%(95%CI：[70，78])，敏感度为49%(95%CI：[34，])，特异度为87%(95%CI：[82，92CI])。结论：4AT-F是一种快速、可靠的筛查勃起功能障碍和认知功能障碍的工具。由于它的管理时间很短，因此可以对有精神错乱危险的患者进行有系统的筛查，而不会显著增加急诊科工作人员的工作量。
Objectives: Delirium is very frequent in older patients presenting to the emergency department (ED), but is often undetected. The purpose of this study was to evaluate the performance of the French version of the 4 A's Test (4AT-F) for the detection of delirium and cognitive impairment in older patients.Methods: The study was conducted in four Canadian ED. Participants (n=320) were independent or semi-independent patients (able to perform >= 5 activities of daily living) aged 65 and older and had an 8-hour exposure to the ED environment. The Telephone Interview for Cognitive Status (TICS-m), the Confusion Assessment Method (CAM) as well as the 4AT-F were administered to patients at the initial interview. The CAM and 4AT-F were then administered twice a day during the patients' ED or hospital stay. The 4AT-F's sensitivity and specificity were compared to those of the CAM (for delirium), and to that of the TICS (for cognitive impairment).Results: Our results suggest that the 4AT-F has a sensitivity of 84% (95% CI: [76, 93]) and a specificity of 74% (95% CI: [70, 78]) for delirium, as well as a sensitivity of 49% (95% CI: [34, 64]) and a specificity of 87% (95% CI: [82, 92]) for cognitive impairment.Conclusion: The 4AT-F is a fast and reliable screening tool for delirium and cognitive impairment in ED. Due to its quick administration time, it allows a systematic screening of patients at risk of delirium, without significantly increasing the workload of the ED staff.