Validating the 4A's test in screening for delirium in a culturally diverse geriatric inpatient population
Validating the 4A's test in screening for delirium in a culturally diverse geriatric inpatient population
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DOI：
10.1002/gps.4615
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发表时间：
2017-12-01
影响因子：
4
通讯作者：
Hunt, Glenn E.
中科院分区：
文献类型：
--
作者：
De, Jayita;Wand, Anne P. F.;Hunt, Glenn E.
目的探讨4A测验在不同文化背景的老年住院患者中的诊断准确性。方法对某三级教学医院老年及正畸住院患者进行前瞻性研究。在同意的情况下，65岁及以上的参与者在入院后72小时内由护理人员用4AT筛查是否有精神错乱。分别由负责临床护理的专家评估员在4AT评估后30min内使用DSM 5标准和混淆评估方法对4AT评分进行盲法诊断。口译员是为不会说英语的病人使用的。由照顾者/亲属填写《老年人认知功能减退调查问卷》以评估可能的痴呆。结果在5个月内共招募了257名参与者，平均年龄85岁。159例(62%)由专家评估师诊断为精神错乱，158例(62%)由4AT评估确诊。共有205名参与者(占总人口的80%)可能患有痴呆症。4AT检测总体精神错乱的敏感度和特异度分别为87%和80%，对可能痴呆患者的敏感度和特异度分别为86%和71%，对非英语受试者的敏感度和特异度为91%和71%。受试者操作特征曲线下面积分别为0.92、0.89和0.90。结论4AT是筛查老年住院患者，包括可能痴呆患者和非英语患者的灵敏而特异的筛查工具。版权所有(C)2016 John Wiley&Sons，Ltd.
ObjectiveTo measure the diagnostic accuracy of the 4A's test in screening for delirium in geriatric inpatients from culturally diverse backgrounds.MethodsA prospective study was conducted with patients admitted to the geriatric and orthogeriatric services of a tertiary teaching hospital. Consenting participants aged 65years and over were screened for delirium with the 4AT by nursing staff within 72h of admission. The diagnosis of delirium was made separately by expert assessors, responsible for the participant's clinical care, blinded to the 4AT score, within 30min of the 4AT assessment using the DSM 5 criteria and the Confusion Assessment Method. Interpreters were used for non-English speaking patients. The Informant Questionnaire for Cognitive Decline in the Elderly was completed by a carer/relative to assess for probable dementia.ResultsA total of 257 participants (mean age 85) were recruited over five months. Delirium was diagnosed in 159 (62%) by the expert assessors and 158 (62%) by the 4AT assessment. A total of 205 participants (80% of total population) had probable dementia. The sensitivity and specificity of the 4AT were 87% and 80%, respectively, in detecting delirium overall, 86% and 71% in people with probable dementia and 91% and 71% for non-English speaking participants. The area under the receiver operating characteristic curve for delirium in the whole population was 0.92, 0.89 in the probable dementia subgroup and 0.90 in non-English speaking participants.ConclusionsThe 4AT is a sensitive and specific screening tool for delirium in geriatric inpatients, including those with probable dementia or who are non-English speaking. Copyright (c) 2016 John Wiley & Sons, Ltd.