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Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis

Author

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  • Eunhye Jeong

    (College of Nursing, Korea University, Seoul 02841, Korea
    These authors contributed equally.)

  • Jinkyung Park

    (College of Nursing, Korea University, Seoul 02841, Korea
    These authors contributed equally.)

  • Juneyoung Lee

    (Department of Biostatistics, College of Medicine, Korea University, Seoul 02841, Korea)

Abstract

Under-recognition of delirium is an international problem. For the early detection of delirium, a feasible and valid screening tool for healthcare professionals is needed. This study aimed to present a scientific reason for using the 4 ‘A’s Test (4AT) through a systematic review and meta-analysis of studies on the diagnostic test accuracy. We systematically searched articles in the EMBASE, MEDLINE, CINAHL, and PsycINFO databases and selected relevant articles on the basis of the predefined inclusion criteria. The quality of the included articles was evaluated using the Quality Assessment of the Diagnostic Accuracy Studies-2 tool. We estimated the pooled values of diagnostic test accuracy by employing the bivariate model and the hierarchical summary receiver operating characteristic (HSROC) model in data synthesis. A total of 3729 patients of 13 studies were included in the analysis. The pooled estimates of sensitivity and specificity of the 4AT were 81.5% (95% confidence interval: 70.7%, 89.0%) and 87.5% (79.5%, 92.7%), respectively. Given the 4AT’s evidence of accuracy and practicality, we suggest healthcare professionals to utilize this tool for routine screening of delirium. However, for detecting delirium in the dementia population, further work is required to evaluate the 4AT with other cut-off points or scoring methods in order for it to be more sensitive and specific.

Suggested Citation

  • Eunhye Jeong & Jinkyung Park & Juneyoung Lee, 2020. "Diagnostic Test Accuracy of the 4AT for Delirium Detection: A Systematic Review and Meta-Analysis," IJERPH, MDPI, vol. 17(20), pages 1-15, October.
    • Handle: RePEc:gam:jijerp:v:17:y:2020:i:20:p:7515-:d:428835
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    References listed on IDEAS

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    1. Peter W. Lange & Marissa Lamanna & Rosie Watson & Andrea B. Maier, 2019. "Undiagnosed delirium is frequent and difficult to predict: Results from a prevalence survey of a tertiary hospital," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(13-14), pages 2537-2542, July.
    2. Alessandro Liberati & Douglas G Altman & Jennifer Tetzlaff & Cynthia Mulrow & Peter C Gøtzsche & John P A Ioannidis & Mike Clarke & P J Devereaux & Jos Kleijnen & David Moher, 2009. "The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-28, July.
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    Cited by:

    1. Eunhye Jeong & Jinkyung Park & Sung Ok Chang, 2020. "Development and Evaluation of Clinical Practice Guideline for Delirium in Long-Term Care," IJERPH, MDPI, vol. 17(21), pages 1-14, November.

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