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Validation of the 4AT for assessing recovery from delirium in older hospital patients
Haruno McCartney, Erin Noble, Kali Thompson, Kseniia Fomina, L Guevara, Daniel H J Davis, Jonathan J. Evans, Susan Deborah Shenkin et al.. Age and Ageing, 2025-05-31
Topic: Risk, prevention and care in population studies
Plain-language summary
A total of 120 people with delirium participated [median age 86.3, range 70-99, 67 (55.8%) female and 55 (45.8%) with dementia]. All of them completed the first two assessments, 103 (85.8%) completed three and 69 (57.5%) four. Reference standard delirium was present in 102/120 (85%), 72/103 (69.9%) and 53/69 (76.8%) cases at assessments two to four, respectively. In Receiver Operating Characteristic analyses, the 4AT's sensitivity for detecting delirium was 0.95 (confidence interval 0.91-0.99), 0.96 (0.91-1) and 0.94 (0.88-1), and specificity was 0.67 (0.13-1), 0.88 (0.71-1) and 1 (1-1) at assessments two to four. In total 18 (15%) participants recovered from delirium. Distress was common in delirium and decreased with recovery. The 4AT maintains diagnostic accuracy on repeated admissions and may effectively assess delirium recovery in acute hospital settings. Fewer patients than expected recovered within 9 days, suggesting more studies on the natural history of delirium in different settings would be informative.
What this study adds
Evidence grade: Low
The record lists 120 participants. The 4AT test kept its accuracy for detecting delirium when repeated, and fewer patients than expected recovered within nine days. Reported effect size: 55.8%; 45.8%; 85.8%.
Taken from this record’s own fields, not from reading the paper. The grade is assigned from the abstract’s wording; what that means.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
McCartney, H., Noble, E., Thompson, K., Fomina, K., Guevara, L., Davis, D. H. J., et al. (2025). Validation of the 4AT for assessing recovery from delirium in older hospital patients. Age and Ageing. https://doi.org/10.1093/ageing/afaf166
Vancouver
McCartney H, Noble E, Thompson K, Fomina K, Guevara L, Davis DHJ, et al. Validation of the 4AT for assessing recovery from delirium in older hospital patients. Age and Ageing. 2025. doi:10.1093/ageing/afaf166. PMID: 40586121.
BibTeX
@article{mccartney2025-40586121,
author = {McCartney, Haruno and Noble, Erin and Thompson, Kali and Fomina, Kseniia and Guevara, L and Davis, Daniel H J and Evans, Jonathan J. and Shenkin, Susan Deborah and others},
title = {{Validation of the 4AT for assessing recovery from delirium in older hospital patients}},
journal = {Age and Ageing},
year = {2025},
doi = {10.1093/ageing/afaf166},
pmid = {40586121},
url = {https://doi.org/10.1093/ageing/afaf166}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
Key findings
- A total of 120 people with delirium participated [median age 86.3, range 70-99, 67 (55.8%) female and 55 (45.8%) with dementia].
- All of them completed the first two assessments, 103 (85.8%) completed three and 69 (57.5%) four.
- Reference standard delirium was present in 102/120 (85%), 72/103 (69.9%) and 53/69 (76.8%) cases at assessments two to four, respectively.
- In Receiver Operating Characteristic analyses, the 4AT's sensitivity for detecting delirium was 0.95 (confidence interval 0.91-0.99), 0.96 (0.91-1) and 0.94 (0.88-1), and specificity was 0.67 (0.13-1), 0.88 (0.71-1) and 1 (1-1) at assessments two to four.
- In total 18 (15%) participants recovered from delirium.
Why it matters
The 4AT test kept its accuracy for detecting delirium when repeated, and fewer patients than expected recovered within nine days. This is about assessing recovery from delirium, not treating or preventing Alzheimer's disease.
Study details
- Participants120
- Effect size55.8%; 45.8%; 85.8%
- Evidence strengthLow
How this study scored 47/100
Published in a peer-reviewed journal. Scored zero for study design and randomized / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Age and Ageing) |
| Journal's citation record | 2 / 4 | Age and Ageing: journal h-index 231 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 2 / 4 | 120 participants |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomized / blinded | 0 / 2 | No randomization or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 4 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.3 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 3 / 6 | Cited 3.1× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 4 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 2 / 4 | Last-listed author Zoë Tieges: h-index 27 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | University College London: institution h-index 2,029 (OpenAlex) |
| Multicenter collaboration | 2 / 3 | OpenAlex lists 8 institution(s) in 2 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 40586121) |
| Free to read | 2 / 2 | Free to read |
| Total | 47 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
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