A cohort study on detecting delirium using 4 ‘A’s Test in a London, UK, hospital

Delirium is a common neuropsychiatric disorder in hospitalised older adults. Often unrecognized, delirium is associated with increased morbidity and mortality, length of hospital stay, institutionalisation and costs to healthcare providers. The objective of this prospective cohort study was to detect the prevalence of delirium in a London (UK) hospital testing the feasibility and reliability of the 4 A's Test (4AT). Over a seven day period 174 inpatients were assessed by non-psychiatrically trained doctors using the 4AT and three widely adopted screening tools. The 4AT helped detect 21 (10.2%) delirious patients uncovering a delirium prevalence of 8.63 per 1000 hospital days. The 4AT showed a compatibility of 75% with other tools used. Changes in consciousness are often missed, but can be easily detected introducing a screening tool as the 4AT.