Skip to main content
×
×
Home

Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department

  • Anne-Julie Gagné (a1) (a2), Philippe Voyer (a1) (a2) (a3), Valérie Boucher (a1) (a2) (a3), Alexandra Nadeau (a1), Pierre-Hugues Carmichael (a3), Mathieu Pelletier (a2) (a4), Emilie Gouin (a5), Simon Berthelot (a2) (a6), Raoul Daoust (a7) (a8), Machelle Wilchesky (a9) (a10) (a11) (a12), Hélène Richard (a3), Isabelle Pelletier (a13), Stephanie Ballard (a12), Antoine Laguë (a1) (a2) and Marcel Émond (a1) (a2) (a3)...
Abstract
CLINICIAN’S CAPSULE

What is known about the topic?

Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A’s Test (4AT), was created and validated for the detection of delirium.

What did this study ask?

This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium.

What did this study find?

The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED).

Why does this study matter to clinicians?

Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment.

Objectif

Le délirium est un trouble très fréquent chez les personnes âgées au département d’urgence (DU), mais il passe souvent inaperçu. L’étude avait pour but d’évaluer la performance de la version française du « 4 A’s Test » (4AT-F) pour la détection du délirium et des troubles cognitifs chez les personnes âgées.

Méthode

L’étude a été menée dans quatre DU, au Canada. Les participants (n = 320) étaient des personnes âgées autonomes ou semi-autonomes (capables de réaliser ≥5 activités de la vie quotidienne), de 65 ans ou plus, qui sont restées au DU durant 8 heures. Les patients ont été soumis, au moment de la première rencontre, aux instruments de dépistage Telephone Interview for Cognitive Status (TICS-m) et Confusion Assessment Method (CAM) ainsi qu’au test 4AT-F. Les instruments CAM et 4AT-F ont été administrés deux fois par jour durant le séjour des patients au DU et durant 24 heures suite à leur admission à l’hôpital. Par la suite, la sensibilité et la spécificité du test 4AT-F ont été comparées à celles du CAM (pour le délirium) et du TICS (pour les troubles cognitifs).

Résultats

D’après les résultats de l’étude, le test 4AT-F aurait une sensibilité de 84 % (IC à 95 % : [76–93]) et une spécificité de 74 % (IC à 95 % : [70–78]) à l’égard du délirium, et une sensibilité de 49 % (IC à 95 % : [34–64]) et une spécificité de 87 % (IC à 95 % : [82–92]) à l’égard des troubles cognitifs.

Conclusions

Le test 4AT-F se révèle donc un instrument rapide et efficace pour la détection du délirium et des troubles cognitifs au DU. Compte tenu de sa rapidité d’administration, il permet un dépistage systématique du délirium chez les patients susceptibles d’en souffrir, sans pour autant augmenter, de manière importante, la charge de travail du personnel au DU.

Copyright
Corresponding author
Correspondence to: Dr. Marcel Émond, CHU de Québec - Hôpital de l’Enfant-Jésus, 1401, 18e rue, H-0608, Québec, QC G1J 1Z4; Email: marcelemond1@me.com
References
Hide All
1. Bellelli, G, Morandi, A, Davis, DH, et al. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing 2014;43(4):496-502.
2. Han, JH, Shintani, A, Eden, S, et al. Delirium in the emergency department: an independent predictor of death within 6 months. Ann Emerg Med 2010;56(3):244-52.e1.
3. Han, JH, Vasilevskis, EE, Shintani, A, et al. Impaired arousal at initial presentation predicts 6-month mortality: an analysis of 1084 acutely ill older patients. J Hosp Med 2014;9(12):772-778.
4. Shenkin, SD, Russ, TC, Ryan, TM, MacLullich, AM. Screening for dementia and other causes of cognitive impairment in general hospital in-patients. Age Ageing 2014;43(2):166-168.
5. Bo, M, Bonetto, M, Bottignole, G, et al. Length of stay in the emergency department and occurrence of delirium in older medical patients. J Am Geriatr Soc 2016;64(5):1114-1119.
6. Émond, M, Grenier, D, Morin, J, et al. Emergency department stay associated delirium in older patients. Can Geriatr J 2017;20(1):10-14.
7. O’Regan, NA, Ryan, DJ, Boland, E, et al. Attention! A good bedside test for delirium? J Neurol Neurosurg Psychiatry 2014;85(10):1122-1131.
8. Oliver, D, consultant in geriatrics and acute general medicine. David Oliver: delirium matters. BMJ 2016;353:i2886.
9. American College of Emergency Physicians; American Geriatrics Society; Emergency Nurses Association; Society for Academic Emergency Medicine; Geriatric Emergency Department Guidelines Task Force. Geriatric emergency department guidelines. Ann Emerg Med 2014;63(5):e7-e25.
10. Inouye, SK, van Dyck, CH, Alessi, CA, et al. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 1990;113(12):941-948.
11. Monette, Galbaud du, Fort, G, Fung, SH, et al. Evaluation of the Confusion Assessment Method (CAM) as a screening tool for delirium in the emergency room. Gen Hosp Psych 2001;23(1):20-25.
12. Knopman, DS, Roberts, RO, Geda, YE, et al. Validation of the telephone interview for cognitive status-modified in subjects with normal cognition, mild cognitive impairment, or dementia. Neuroepidemiology 2010;34(1):34-42.
13. Lees, R, Corbet, S, Johnston, C, et al. Test accuracy of short screening tests for diagnosis of delirium or cognitive impairment in an acute stroke unit setting. Stroke 2013;44(11):3078-3083.
14. de Jager, CA, Budge, MM, Clarke, R. Utility of TICS-M for the assessment of cognitive function in older adults. Int J Geriatr Psychiatry 2003;18(4):318-324.
15. McCusker, J, Bellavance, F, Cardin, S, Belzile, E. Validity of an activities of daily living questionnaire among older patients in the emergency department. J Clin Epidemiol 1999;52(11):1023-1030.
16. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40(5):373-383.
17. Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818-829.
18. Genders, TS, Spronk, S, Stijnen, T, et al. Methods for calculating sensitivity and specificity of clustered data: a tutorial. Radiology 2012;265(3):910-916.
19. 4AT rapid clinical test for delirium; 2014. Available at: http:///www.the4at.com (accessed 2017).
20. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington DC: American Psychiatric Association; 2000.
21. Kuladee, S, Prachason, T. Development and validation of the Thai version of the 4 ‘A’s Test for delirium screening in hospitalized elderly patients with acute medical illnesses. Neuropsychiatr Dis Treat 2016;12:437-443.
22. Vogel, SJ, Banks, SJ, Cummings, JL, Miller, JB. Concordance of the Montreal cognitive assessment with standard neuropsychological measures. Alzheimers Dement (Amst) 2015;1(3):289-294.
23. O’Sullivan, D, Brady, N, Manning, E, et al. Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees. Age Ageing 2018;47(1):61-68.
24. Han, JH, Wilson, A, Graves, AJ, et al. Validation of the Confusion Assessment Method for the Intensive Care Unit in older emergency department patients. Acad Emerg Med 2014;21(2):180-187.
25. Han, JH, Wilson, A, Vasilevskis, EE, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med 2013;62(5):457-465.
26. Marcantonio, ER, Ngo, LH, O’Connor, M, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med 2014;161(8):554-561.
27. Voyer, P, Champoux, N, Desrosiers, J, et al. Assessment of inattention in the context of delirium screening: one size does not fit all! Int Psychogeriatr 2016;28(8):1293-1301.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Canadian Journal of Emergency Medicine
  • ISSN: -
  • EISSN: 1481-8035
  • URL: /core/journals/canadian-journal-of-emergency-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Gagné et al. supplementary material 1
Appendix

 PDF (286 KB)
286 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed