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

    Disease

    Select...

    Specialty

    Select...

    Chief Complaint

    Select...

    Organ System

    Select...

    Patent Pending

    Log In

    Show
    Forgot your password?
    Log In
    Or create a new account (it's free)

    Forgot Password?

    Enter your email address and we'll send you a link to reset your password.

    Get New Password

    Sign In Required

    To save favorites, you must log in.

    Creating an account is free, easy, and takes about 60 seconds.

    Already have an MDCalc account?

    Login to link your favorites and recently used calcs

    Show
    Forgot your password?
    Log In
    Or continue to Nuance

    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    4 A’s Test for Delirium Screening

    Diagnoses delirium in older patients.
    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:

    Please fill out required fields.

    Next Steps
    Evidence
    Creator Insights
    Dr. Alasdair MacLullich

    About the Creator

    Alasdair MacLullich, BSc, MB ChB, MRCP(UK), PhD, FRCPE, is a professor of geriatric medicine at the University of Edinburgh in Scotland. He also leads the Edinburgh Delirium Research Group working to improve the understanding, detection and treatment of delirium. Dr. MacLullich's primary reseach is focused on the pathophysiology, neuropathology, and clinical assessment of delirium.

    To view Dr. Alasdair MacLullich's publications, visit PubMed

    Are you Dr. Alasdair MacLullich? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
    About the Creator
    Dr. Alasdair MacLullich
    Are you Dr. Alasdair MacLullich?
    Also from MDCalc...