4AT validation study in SPC inpatient unit
Research type
Research Study
Full title
Preliminary Validation study of the 4AT delirium assessment tool in a Specialist Palliative Care Inpatient Unit.
IRAS ID
262658
Contact name
Alasdair MacLullich
Contact email
Sponsor organisation
University of Edinburgh
Duration of Study in the UK
1 years, 3 months, 0 days
Research summary
Delirium is a severe acute deterioration in mental functioning, mostly brought on by acute illness or the side effects of drugs. In contrast to dementia, delirium emerges rapidly, over hours or days. Prevalence studies show that 13-42% of patients admitted to specialist palliative care inpatient units have delirium, and up to 88% of those in the hours or weeks preceding death. It is often unrecognised, misdiagnosed as fatigue or depression or recognised at a late stage. A study of a hospital palliative care unit suggested 50% of delirium cases were reversible. Patients admitted to palliative care units are often fatigued with significant symptom burden, hence a quick, valid and reliable detection tool for delirium is required.
We will study the 2 minute test for delirium called the 4AT (www.the4AT.com).
The 4AT assesses level of alertness, cognition (orientation and attention) and presence of an acute change in mental status. The 4AT is already used in many clinical units. It has been validated in hospital settings, and further tests of its diagnostic accuracy are underway.The tool is already used for delirium detection in specialist palliative care populations. However, it has not been validated in a palliative care context.
We will recruit approximately 100 patients aged 18 or over from a specialist palliative care inpatient unit. We will compare the performance of the 4AT with a reference standard delirium assessment. Participants will undergo the 4AT and the reference standard delirium assessment.
The study will provide an assessment of the performance of the 4AT as a rapid, practical tool for the detection of delirium in a specialist palliative care in-patient unit.
REC name
Scotland A: Adults with Incapacity only
REC reference
19/SS/0091
Date of REC Opinion
8 Aug 2019
REC opinion
Favourable Opinion