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A study to assess a tool to diagnose Delirium

By August 19, 2015November 14th, 2023No Comments

Recruitment to the 4AT study opens week beginning 12th October.

Emerge is excited about this first collaboration with Medicine of the Elderly and hope the study will lead to wider validation of the 4AT delirium triage tool and also improvements in elderly patient care.

The 4AT is a tool that aims to identify patients who have delirium – a common condition that is associated with poor outcomes and that often goes undetected. This familiar screening tool is used as part of admission bundles in the majority of specialities here at the Royal Infirmary of Edinburgh, including the Emergency Department.

The 4AT is a particularly useful tool in the Emergency Department because it is quick and simple to complete. By identifying these patients early, the cause of their delirium can be addressed, for example – an infection or medication toxicity. Delirium can be a potentially traumatic condition for patients and by recognising it early, a patient’s distress can be alleviated.

The 4AT study aims to determine how accurate the 4AT is in detecting delirium. To do so, we are going to compare the results from the 4AT to the gold standard procedure for detecting delirium – a 20 minute interview with patients. This means that for 300 patients over 75 years of age research nurses will be conducting two diagnostic tests – the 4AT (or CAM also a delirium screening tool) and the 20 minute interview.

This is the first time we have embarked on a study specifically focusing on Medicine of the Elderly within the context of the Emergency Department. We hope that it will be the start of many. After all, older people make up a considerable proportion of our patient group in the ED, they have specific needs because they often have complex medical and social issues and are more likely to be admitted to hospital. We need to ensure that we are able to identify and meet these needs – delirium being one of many.

We are very happy to be working with Professor Alasdair MacLullich, Professor of Geriatric Medicine on this study.

For further information please contact Polly Black / 4AT Study team on 0131 242 3860 or email