Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm

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    Patent Pending

    4 A’s Test for Delirium Screening

    Diagnoses delirium in older patients.
    Favorite
    When to Use
    Pearls/Pitfalls
    Why Use

    Patients admitted to geriatric wards, to screen for delirium.

    • Screens with higher sensitivity in patients without dementia.
    • No consensus exists for the assessment of inattention.
    • Limited external validation in some small populations, including the acute stroke setting.
    • Validated in non-English speaking patients with 91% sensitivity (De 2016).
    • Delirium is misdiagnosed, missed, or diagnosed late in over 60% of cases (Collins 2010). A simple screening tool can help identify these patients.
    • Can be used in patients deemed “untestable” by other tests.
    Normal
    0
    Mild sleepiness for <10 seconds after waking, then normal
    0
    Clearly abnormal
    +4
    No mistakes
    0
    1 mistake
    +1
    ≥2 mistakes or untestable
    +2
    Lists ≥7 months correctly
    0
    Starts but lists <7 months, or refuses to start
    +1
    Untestable (cannot start because unwell, drowsy, inattentive)
    +2
    No
    0
    Yes
    +4

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    If delirium is diagnosed, identify and treat underlying cause.

    About the Creator
    Dr. Giuseppe Bellelli
    Are you Dr. Giuseppe Bellelli?