4AT delirium assessment tool on admission links to outcomes: 2 centre study of 82,770 patients скачать в хорошем качестве

4AT delirium assessment tool on admission links to outcomes: 2 centre study of 82,770 patients

Presentation for the American Delirium Society meeting, June 2022. From this published study: doi.org/10.1093/ageing/afac051 Key points: Prior research studies have linked delirium with mortality, length of stay and other adverse outcomes. Policy guidelines advocate effective delirium detection and care but delirium is mostly undetected in practice. There is a lack of large scale research demonstrating links between routinely collected delirium assessments and outcomes. We show in a large study that the 4AT delirium test completed by clinical staff is linked with outcomes e.g. 30-day mortality. Real-time delirium assessment at scale with the 4AT is feasible and yields findings of immediate and longer-term clinical significance. Abstract Background: Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 ‘A’s Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay and home time (days at home in the year following admission). Methods: The 4AT was performed as part of usual care. Data from emergency admissions in patients ≥65 years in Lothian, UK (n = 43,946) and Salford, UK (n = 38,824) over a period of ∼3 years were analysed using logistic regression models adjusted for age and sex. Results: 4AT completion rates were 77% in Lothian and 49% in Salford. 4AT scores indicating delirium (4+/12) were present in 18% of patients in Lothian, and 25% of patients in Salford. Thirty-day mortality with 4AT 4+ was 5.5-fold greater than the 4AT 0/12 group in Lothian (adjusted odds ratio (aOR) 5.53, 95% confidence interval [CI] 4.99–6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98–3.87). Length of stay was more than double in patients with 4AT scores of 1–3/12 (indicating cognitive impairment) or 4+/12 compared with 4AT 0/12. Median home time at 1 year was reduced by 112 days (Lothian) and 61 days (Salford) in the 4AT 4+ group (P less than 0.001). Conclusions: Scores on the 4AT used at scale in practice are strongly linked with 30-day mortality, length of hospital stay and home time. The findings highlight the need for better understanding of why delirium is linked with poor outcomes and also the need to improve delirium detection and treatment.