Delirium screening in critically ill patients: validation of the Korean version of the 4 A's Test

Abstract

Background: Delirium is one of the common diseases in patients admitted to intensive care units (ICUs) and is associated with ICU mortality and post intensive care syndrome. The 4A’s Test (4AT) was created and validated in order to evaluate cognitive impairment and delirium in hospitalized patients. The 4AT requires no special training and takes only a short time (eg 2 minutes) to apply to a patient. The usefulness of 4AT was not clarified in critically ill patients.

Aims and objectives: To validate the Korean version of the 4AT for detecting delirium of critically ill patients.

Methods: This study was a prospective observation study and was performed on critically ill patients at four university affiliated hospitals between July 2021 and February 2022. Delirium was evaluated in patients who were not intubated or extubated using the Korean version of 4AT and the Korean version of the CAM-ICU.

Results: Total 89 patients were included and total 370 sessions were conducted in this study. The median age of these patients was 60 years and 49 (55.1%) were male. Nine patients (9%) were diagnosed with delirium based on the Korean version of the CAM-ICU. The Korean version of 4 AT had reliable internal consistency (α = 0.968) and showed sensitivity of 91.7% and specificity of 99.7% at the optimal cutoff score for diagnosing delirium of 4.

Conclusions: The Korean version of 4 AT showed acceptable reliability and validity for detecting delirium in critically ill patients. Considering the 4AT was a simpler tool than the CAM-ICU, this scale could be useful tool to detect delirium in critically ill patients.