The delirium screening tool 4AT in routine clinical practice: prediction of mortality, sensitivity and specificity.
The delirium screening tool 4AT in routine clinical practice: prediction of mortality, sensitivity and specificity.
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DOI：
10.1007/s41999-021-00489-1
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发表时间：
2021-08
影响因子：
3.8
通讯作者：
Saltvedt I
中科院分区：
文献类型：
--
作者：
Evensen S;Hylen Ranhoff A;Lydersen S;Saltvedt I
研究4AT评分是否可以预测一年的死亡率，并探索4AT作为临床常规应用时的敏感性和特异性。4AT评分是预测1年死亡率的几个临床特征之一。在临床常规情况下，4AT具有较高的灵敏度和特异度。4AT似乎是一种有用的幻觉筛查工具，并可预测死亡率。精神错乱很常见，并与不良结局有关，部分原因是未被发现。我们调查了精神错乱筛查工具4A测试(4AT)评分是否可以预测一年的死亡率，并探索了4AT作为临床常规应用时的敏感性和特异性。内科老年病房入院的228名患者的前瞻性研究的二次分析。没有接受过正式培训的医生进行了指数测试(4AT)；预先定义的临界值 ≥ 为4，提示为精神错乱。参考标准是两名老年医生使用《精神疾病诊断和统计手册5》(DSM-5)诊断为精神错乱。我们根据4AT = 0，1-3，4-7和 ≥ 8组使用COX回归计算危险比(HR)，首先未调整，然后根据协变量年龄、合并症和个人日常生活能力进行调整。计算灵敏度、特异度和受试者工作曲线下面积(AUC)。患者平均年龄86.6岁，女性139例(61.0%)，DSM-5型妄想78例(34.2%)，其中4AT-妄想56例。1年死亡率为27.6%(63例)。与4AT评分0相比，4AT ≥ 8组的1年死亡率增加(HR2.86，95%可信区间1.28~6.37，p = 0.010)。在多因素调整分析中，这种影响被降低(HR1.69，95%可信区间0.70-4.07，p = 0.24)。敏感度、特异度和AUC分别为0.72、0.84和0.88。4在 ≥ 为8时，死亡率增加，但在多因素调整分析中，这种影响降低了。4AT作为临床常规应用具有较好的敏感性和特异性。
Investigate if 4AT score predicts 1 year mortality and explore the sensitivity and specificity of the 4AT when applied as part of a clinical routine. 4AT score is one of several clinical characteristics predicting 1 year mortality. The 4AT has reasonable sensitivity and specificity to detect delirium in a clinical routine setting. The 4AT seems to be a useful tool for delirium screening and may predict mortality. Delirium is common and associated with poor outcomes, partly due to underdetection. We investigated if the delirium screening tool 4 A’s test (4AT) score predicts 1 year mortality and explored the sensitivity and specificity of the 4AT when applied as part of a clinical routine. Secondary analyses of a prospective study of 228 patients acutely admitted to a Medical Geriatric Ward. Physicians without formal training conducted the index test (the 4AT); a predefined cut-off ≥ 4 suggested delirium. Reference standard was delirium diagnosed by two geriatricians using the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). We calculated hazard ratios (HR) using Cox regression based on the groups 4AT = 0, 1–3, 4–7 and ≥ 8, first unadjusted, then adjusted for the covariates age, comorbidity, and personal activities of daily living. We calculated sensitivity, specificity, and the area under the receiver operating curve (AUC). Mean age of patients was 86.6 years, 139 (61.0%) were female, 78 (34.2%) had DSM-5 delirium; of these, 56 had 4AT-delirium. 1 year mortality was 27.6% (63 patients). Compared to 4AT score 0, the group 4AT ≥ 8 had increased 1 year mortality (HR 2.86, 95% confidence interval 1.28–6.37, p = 0.010). The effect was reduced in multiadjusted analyses (HR 1.69, 95% confidence interval 0.70–4.07, p = 0.24). Sensitivity, specificity, and AUC were 0.72, 0.84, and 0.88, respectively. 4AT ≥ 8 indicates increased mortality, but the effect was reduced in multiadjusted analyses. 4AT had acceptable sensitivity and specificity when applied as a clinical routine.
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影响因子：
4.7
作者：
Breitbart, W;Rosenfeld, B;Passik, S
通讯作者：
Passik, S
影响因子：
2.4
作者：
Gagne, Anne-Julie;Voyer, Philippe;Emond, Marcel
通讯作者：
Emond, Marcel
影响因子：
4
作者：
De, Jayita;Wand, Anne P. F.;Hunt, Glenn E.
通讯作者：
Hunt, Glenn E.
影响因子：
3.8
作者：
Myrstad, Marius;Watne, Leiv O.;Neerland, Bjorn E.
通讯作者：
Neerland, Bjorn E.
DOI：
10.1056/nejmcp1605501
发表时间：
2017-10-12
期刊：
The New England journal of medicine
影响因子：
--
作者：
Marcantonio ER
通讯作者：
Marcantonio ER