4AT diagnostic test accuracy (validation) studies

All 4AT diagnostic test accuracy (validation) studies, listed in reverse chronological order (most recent first).

33. Lawson RA, Richardson SJ, Gerakios F, Yarnall AJ, Bate G, Wright L, McDonald C, Taylor JP, Burn D, Stebbins G, Allan LM. Detecting delirium in Parkinson's disease: an evaluation of diagnostic accuracy of bedside tools. Age Ageing. 2025 Jul 1;54(7):afaf197. doi: 10.1093/ageing/afaf197.

32. McCartney H, Noble E, Thompson K, Fomina K, Guevara LM, Davis DHJ, Evans J, Shenkin SD, Muniz G, Sandeman D, MacLullich AMJ, Tieges Z. Validation of the 4AT for assessing recovery from delirium in older hospital patients. Age Ageing. 2025 May 31;54(6):afaf166. doi: 10.1093/ageing/afaf166.

31. Lai YH, Lin CJ, Su IC, Huang SW, Hsiao CC, Jao YL, Chen PY, Traynor V, Lee CY, Chen TJ, Ho MH, Chiu HY. Clinical Utility and Performance of the Traditional Chinese Version of the 4-As Test for Delirium due to Traumatic Brain Injury. J Acad Consult Liaison Psychiatry. 2025 Jan 4:S2667-2960(24)00140-X.

30. Fabrizi D, Rebora P, Spedale V, Locatelli G, Bellelli G, Di Mauro S, Ausili D, Luciani M. Diagnostic Accuracy of the Recognizing Acute Delirium as Part of Your Routine (RADAR) Scale for Delirium Assessment in Hospitalized Older Adults: A Cross-Sectional Study. Healthcare (Basel). 2024 Jun 28;12(13):1294.

29. Sim JK, Chung K, Chung CR, Lee J, Hwang SY, Lee YS. Usefulness of the 4A's test for detecting delirium in critically ill patients: a multicenter prospective observation study. Intern Emerg Med. 2024 Oct;19(7):1839-1846.

28. Arnold E, Finucane AM, Taylor S, Spiller JA, O'Rourke S, Spenceley J, Carduff E, Tieges Z, MacLullich AM. The 4AT, a rapid delirium detection tool for use in hospice inpatient units: Findings from a validation study. Palliat Med. 2024 May;38(5):535-545.

27. Soler-Sanchis A, Martínez-Arnau FM, Sánchez-Frutos J, Pérez-Ros P. The 4AT scale for rapid detection of delirium in emergency department triage. Front Med (Lausanne). 2024 May 14;11:1345983.

26. Morales-Puerto M, Ruiz-Díaz M, García-Mayor S, León-Campos Á, Morales-Asencio JM, Canca-Sánchez JC, Gavira-Guerra S, Toledo-Fernandez C, Aranda-Gallardo M. Spanish transcultural adaptation of the 4AT score for the evaluation of delirium in the emergency department: a prospective diagnostic test accuracy study. BMC Nurs. 2024 Feb 6;23(1):101. doi: 10.1186/s12912-023-01638-6.

25. Pouw MA, Calf AH, Georg RR, de Rooij SE, Ter Maaten JC, van Munster BC. Diagnostic accuracy of the Dutch version of the 4AT for delirium detection in a mixed patient population and setting. Aging Clin Exp Res. 2023 Aug;35(8):1705-1710.

24. Muzzana C, Mantovan F, Tappeiner W, Niederbacher S, Huber MK, Ausserhofer D. Interrater Reliabilität und Übereinstimmungsvalidität des 4AT zur Erfassung des postoperativen Delirs [Interrater reliability and concurrent validity of 4AT for the detection of postoperative delirium: A prospective cohort study]. Pflege. 2023 Aug;36(4):189-197. German.

23. Delgado-Parada E, Morillo-Cuadrado D, Saiz-Ruiz J, Cebollada-Gracia A, Ayuso-Mateos JL, Cruz-Jentoft AJ. Diagnostic accuracy of the Spanish version of the 4AT scale (4AT-ES) for delirium screening in older inpatients. European Journal of Psychiatry. 2022 36(3):182-90

22. Aldwikat RK, Manias E, Holmes A, Tomlinson E, Nicholson P. Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study. Int J Environ Res Public Health. 2022 Nov 30;19(23):16020.

21. Hur HJ, Jang YN, Park HY, Lee YS, Ro DH, Kang B, Song KH, Park HY. A prospective study of remote delirium screening using the modified K-4AT for COVID-19 inpatients. Front Psychiatry. 2022 Aug 18;13:976228.

20. Hasegawa T, Seo T, Kubota Y, Sudo T, Yokota K, Miyazaki N, Muranaka N, Hirano S, Yamauchi A, Nagashima K, Iyo M, Sakai I. Reliability and validity of the Japanese version of the 4A's Test for delirium screening in the elderly patient. Asian Journal of Psychiatry, 2021, 102918.

19. Johansson YA, Tsevis T, Nasic S, Gillsjö C, Johansson L, Bogdanovic N, Kenne Sarenmalm E. Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting. BMC Geriatr. 2021 Oct 18;21(1):568.

18. Evensen S, Hylen Ranhoff A, Lydersen S, Saltvedt I. The delirium screening tool 4AT in routine clinical practice: prediction of mortality, sensitivity and specificity. Eur Geriatr Med. 2021 Aug;12(4):793-800.

17. Chang Y, Ragheb SM, Oravec N, Kent D, Nugent K, Cornick A, Hiebert B, Rudolph JL, MacLullich AMJ, Arora RC. Diagnostic accuracy of the "4 A's Test" delirium screening tool for the postoperative cardiac surgery ward. J Thorac Cardiovasc Surg. 2021 Jun 1:S0022-5223(21)00876-X.

16. Sepúlveda E, Bermúdez E, González D, Cotino P, Viñuelas E, Palma J, Ciutat M, Grau I, Vilella E, Trzepacz PT, Franco JG. Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) in a skilled nursing facility and comparison to the 4 'A's test (4AT). Gen Hosp Psychiatry. 2021 May-Jun;70:116-123.

15. Shenkin SD, Fox C, Godfrey M, Siddiqi N, Goodacre S, Young J, Anand A, Gray A, Hanley J, MacRaild A, Steven J, Black PL, Tieges Z, Boyd J, Stephen J, Weir CJ, MacLullich AMJ. Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the Confusion Assessment Method. BMC Med. 2019 Jul 24;17(1):138

14. Myrstad M, Watne LO, Johnsen NT, Børs-Lind E, Neerland BE. Delirium screening in an acute geriatric ward by nurses using 4AT: results from a quality improvement project. Eur Geriatr Med. 2019 Aug;10(4):667-671.

13. Saller T, MacLullich AMJ, Schäfer ST, Crispin A, Neitzert R, Schüle C, von Dossow V, Hofmann-Kiefer KF. Screening for delirium after surgery: validation of the 4 A's test (4AT) in the post-anaesthesia care unit. Anaesthesia. 2019;74:1260-1266

12. Gagné AJ, Voyer P, Boucher V, Nadeau A, Carmichael PH, Pelletier M, Gouin E, Berthelot S, Daoust R, Wilchesky M, Richard H, Pelletier I, Ballard S, Laguë A, Émond M. Performance of the French version of the 4AT for screening the elderly for delirium in the emergency department. CJEM. 2018 Nov;20:903-910

11. O'Sullivan D, Brady N, Manning E, O'Shea E, O'Grady S, O 'Regan N, Timmons S. Validation of the 6-Item Cognitive Impairment Test and the 4AT test for combined delirium and dementia screening in older Emergency Department attendees. Age Ageing. 2018; 47:61-68

10. Al-Jumayli M, Hiner JA, Taffet GE, Agarwal KS. Use of the 4AT to detect delirium in older hospitalized cancer patients. J Am Geriatr Soc 2018; 66: S33. Abstract image.

9. Infante MT, Pardini M, Balestrino M, Finocchi C, Malfatto L, Bellelli G, Mancardi GL, Gandolfo C, Serrati C. Delirium in the acute phase after stroke: comparison between methods of detection. Neurol Sci. 2017; 386:1101-1104

8. De J, Wand AP, Smerdely PI, Hunt GE. Validating the 4A's test in screening for delirium in a culturally diverse geriatric inpatient population. Int J Geriatr Psychiatry. 2017; 32:1322-1329

7. Hendry K, Quinn TJ, Evans J, Scortichini V, Miller H, Burns J, Cunnington A, Stott DJ. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age Ageing. 2016; 45:832-837

6. Kazim R, MacLullich AMJ, Taffet GE, Agarwal KS. 4AT screening tool used by nurses is both sensitive and specific for detection of delirium in hospitalized elders. 7th Annual Meeting of the American Delirium Society; 2016; Nashville, Tennessee, USA.

5. Kuladee S, Prachason T. Development and validation of the Thai version of the 4 'A's Test for delirium screening in hospitalized elderly patients with acute medical illnesses. Neuropsychiatr Dis Treat. 2016; 12:437-43

4. Asadollahi A, Saberi M, Entezari M, Hoseini Z, Hasani SA, Saberi LF. Iranian version of 4AT, an instrument for rapid delirium screening for later life. Int J Adv Appl Sci 2016; 3: 33–8.

3. Kutlubaev MA, Bikbulatova LF, Akhmadeeva LR. [Early diagnosing of delirium in the elderly with acute stroke]. Advances in gerontology = Uspekhi gerontologii. 2015;28(3):493-9. [Russian]

2. Bellelli G, Morandi A, Davis DH, Mazzola P, Turco R, Gentile S, Ryan T, Cash H, Guerini F, Torpilliesi T, Del Santo F, Trabucchi M, Annoni G, MacLullich AM. Validation of the 4AT, a new instrument for rapid delirium screening: a study in 234 hospitalised older people. Age Ageing. 2014; 43:496-502

1. Lees R, Corbet S, Johnston C, Moffitt E, Shaw G, Quinn TJ. Test accuracy of short screening tests for diagnosis of delirium or cognitive impairment in an acute stroke unit setting. Stroke. 2013; 44:3078-83