4AT
Validated4AT — Assessment Test for Delirium & Cognitive Impairment
Older adults (65+) in hospital and other acute settingsClinician~2 min4 questions
Items 1–3 are rated solely on observation of the patient at the time of assessment. Item 4 requires information from one or more source(s), e.g. your own knowledge of the patient, other staff who know the patient (e.g. ward nurses), GP letter, case notes, carers. Take account of communication difficulties (hearing impairment, dysphasia, lack of common language) when carrying out the test and interpreting the score.
Report details · optional
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About this screener — evidence, source
A rapid clinician-administered assessment for delirium and cognitive impairment, recommended by the UK NICE delirium guideline. Items 1–3 are rated by observing and testing the patient at the time of assessment; item 4 uses information from staff, carers or records. Scores of 4 or more suggest possible delirium; 1–3 suggest possible cognitive impairment.
Evidence · validated
In a systematic review and meta-analysis of 17 studies (3,702 observations) in adults aged 65+ in acute medicine, surgery, a care home and the emergency department, pooled sensitivity was 0.88 (95% CI 0.80–0.93) and pooled specificity 0.88 (0.82–0.92) for delirium (Tieges et al., Age Ageing 2021;50:733–743).
Source & licence
4AT © 2011–2014 Alasdair MacLullich, Tracy Ryan and Helen Cash. Version 1.2. Bellelli G, Morandi A, Davis DH, et al. Validation of the 4AT, a new instrument for rapid delirium screening. Age Ageing. 2014;43(4):496–502.
Licence: Licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/) — free to copy, share and adapt with attribution.
Official and current version: https://www.the4at.com/. No changes have been made to item wording, scoring or interpretation; the form is presented as an online checklist. No warranty is given as to accuracy or fitness for purpose. The 4AT developers do not endorse this site.
Official source ↗