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Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department

  • Anne-Julie Gagné (a1) (a2), Philippe Voyer (a1) (a2) (a3), Valérie Boucher (a1) (a2) (a3), Alexandra Nadeau (a1), Pierre-Hugues Carmichael (a3), Mathieu Pelletier (a2) (a4), Emilie Gouin (a5), Simon Berthelot (a2) (a6), Raoul Daoust (a7) (a8), Machelle Wilchesky (a9) (a10) (a11) (a12), Hélène Richard (a3), Isabelle Pelletier (a13), Stephanie Ballard (a12), Antoine Laguë (a1) (a2) and Marcel Émond (a1) (a2) (a3)...

Abstract

Objectives

Delirium is very frequent in older patients presenting to the emergency department (ED), but is often undetected. The purpose of this study was to evaluate the performance of the French version of the 4 A’s Test (4AT-F) for the detection of delirium and cognitive impairment in older patients.

Methods

The study was conducted in four Canadian ED. Participants (n= 320) were independent or semi-independent patients (able to perform ≥5 activities of daily living) aged 65 and older and had an 8-hour exposure to the ED environment. The Telephone Interview for Cognitive Status (TICS-m), the Confusion Assessment Method (CAM) as well as the 4AT-F were administered to patients at the initial interview. The CAM and 4AT-F were then administered twice a day during the patients’ ED or hospital stay. The 4AT-F’s sensitivity and specificity were compared to those of the CAM (for delirium), and to that of the TICS (for cognitive impairment).

Results

Our results suggest that the 4AT-F has a sensitivity of 84% (95% CI: [76, 93]) and a specificity of 74% (95% CI: [70, 78]) for delirium, as well as a sensitivity of 49% (95% CI: [34, 64]) and a specificity of 87% (95% CI: [82, 92]) for cognitive impairment.

Conclusion

The 4AT-F is a fast and reliable screening tool for delirium and cognitive impairment in ED. Due to its quick administration time, it allows a systematic screening of patients at risk of delirium, without significantly increasing the workload of the ED staff.

Objectif

Le délirium est un trouble très fréquent chez les personnes âgées au département d’urgence (DU), mais il passe souvent inaperçu. L’étude avait pour but d’évaluer la performance de la version française du « 4 A’s Test » (4AT-F) pour la détection du délirium et des troubles cognitifs chez les personnes âgées.

Méthode

L’étude a été menée dans quatre DU, au Canada. Les participants (n = 320) étaient des personnes âgées autonomes ou semi-autonomes (capables de réaliser ≥5 activités de la vie quotidienne), de 65 ans ou plus, qui sont restées au DU durant 8 heures. Les patients ont été soumis, au moment de la première rencontre, aux instruments de dépistage Telephone Interview for Cognitive Status (TICS-m) et Confusion Assessment Method (CAM) ainsi qu’au test 4AT-F. Les instruments CAM et 4AT-F ont été administrés deux fois par jour durant le séjour des patients au DU et durant 24 heures suite à leur admission à l’hôpital. Par la suite, la sensibilité et la spécificité du test 4AT-F ont été comparées à celles du CAM (pour le délirium) et du TICS (pour les troubles cognitifs).

Résultats

D’après les résultats de l’étude, le test 4AT-F aurait une sensibilité de 84 % (IC à 95 % : [76–93]) et une spécificité de 74 % (IC à 95 % : [70–78]) à l’égard du délirium, et une sensibilité de 49 % (IC à 95 % : [34–64]) et une spécificité de 87 % (IC à 95 % : [82–92]) à l’égard des troubles cognitifs.

Conclusions

Le test 4AT-F se révèle donc un instrument rapide et efficace pour la détection du délirium et des troubles cognitifs au DU. Compte tenu de sa rapidité d’administration, il permet un dépistage systématique du délirium chez les patients susceptibles d’en souffrir, sans pour autant augmenter, de manière importante, la charge de travail du personnel au DU.

Copyright

Corresponding author

Correspondence to: Dr. Marcel Émond, CHU de Québec - Hôpital de l’Enfant-Jésus, 1401, 18e rue, H-0608, Québec, QC G1J 1Z4; Email: marcelemond1@me.com

References

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