Whats New in the Patient Safety World
August 2014
A New Rapid Screen for Delirium in the Elderly
Weve discussed the
importance of recognizing delirium in multiple columns (see the list at the end
of todays column). Yet delirium goes unrecognized or undiagnosed in up to 72%
of cases in hospitalized patients (Collins
2010). One of the reasons may be that commonly used screening tests for
delirium may not be brief enough or may require specific training for
administration.
So researchers have
developed a new screening tool, the 4 As
Test (4AT) to help improve screening for delirium.
The 4AT tool has now been validated in a population other than that in which it was developed (Bellelli 2014). The authors note that the many of the currently used screening tools for delirium lack some of the following characteristics:
- Brevity
- No special training required
- Simple to administer
- Does not require physical responses
- Allows for assessment of untestable patients
- Incorporates general cognitive screening
Bellelli and colleagues therefore administered
the 4AT in 236 consecutive elderly patients admitted to an acute geriatrics
ward or a post-acute rehabilitation unit. The CAM (Confusion Assessment Method)
was used as the reference diagnostic standard and the DSM-IV-TR criteria used
for diagnosis. Delirium was detected in
12.3%, dementia in 31.2%, and a combination of both in 7.2%. The 4AT had a
sensitivity of 89.7% and specificity 84.1% for delirium. Specificity was higher
in the subgroup without dementia, while sensitivity was higher in the group
with dementia. The authors conclude that the 4AT is a sensitive and specific
method of screening for delirium in hospitalized older people and that its
brevity and simplicity support its use in routine clinical practice.
We recommend that,
if youve been using a validated tool like the CAM and have been using it
regularly to screen for delirium, you continue to use it. But if you have not
been regularly screening for delirium, consider giving the 4AT a try. Its
simple and easy to administer and appears to be a reliable tool.
Some of our prior
columns on delirium assessment and management:
·
October
21, 2008 Preventing
Delirium
·
October
14, 2009 Managing
Delirium
·
February
10, 2009 Sedation
in the ICU: The Dexmedetomidine Study
·
March
31, 2009 Screening
Patients for Risk of Delirium
·
June 23,
2009 More
on Delirium in the ICU
·
January
26, 2010 Preventing
Postoperative Delirium
·
August
31, 2010 Postoperative
Delirium
·
September
2011 Modified
HELP Helps Outcomes in Elderly Undergoing Abdominal Surgery
· December 2010 The ABCDE Bundle
·
February
28, 2012 AACN
Practice Alert on Delirium in Critical Care
·
April 3, 2012 New
Risk for Postoperative Delirium: Obstructive Sleep Apnea
·
August
7, 2012 Cognition,
Post-Op Delirium, and Post-Op Outcomes
·
September
2013 Disappointing
Results in Delirium
·
October
29, 2013 PAD:
The Pain, Agitation, and Delirium Care Bundle
·
February
2014 New
Studies on Delirium
·
March
25, 2014 Melatonin
and Delirium
·
May 2014
New
Delirium Severity Score
References:
Collins N, Blanchard MR, Tookman A, Sampson EL. Detection of delirium in the acute hospital. Age Ageing 2010; 39 (1): 131-135
http://ageing.oxfordjournals.org/content/39/1/131.full.pdf+html
The 4 As Test: screening instrument for delirium and cognitive impairment
Bellelli G, Morandi A, Davis DHJ, 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
http://ageing.oxfordjournals.org/content/43/4/496.full.pdf+html
Print PDF
version
http://www.patientsafetysolutions.com/