University of Hertfordshire

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

Research output: Contribution to journalArticlepeer-review

  • Annalisa Casarin
  • Pranev Sharma
  • Satyawan Bhat
  • Marcela P Vizcaychipi
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Original languageEnglish
Pages (from-to)29-34
Number of pages6
JournalResearch & Reviews: Journal of Nursing and Health Sciences
Publication statusPublished - 14 Feb 2016


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.


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