DOI
10.1016/j.ajp.2022.103374
Diagnostic accuracy of the 4AT for delirium: A systematic review and meta-analysis
作者地址
Evidence Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou 730000, China
;
Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou 730000, China
来源期刊
DIABETES-METABOLISM RESEARCH AND REVIEWS
摘要
Introduction: Despite common, serious, costly, and often fatal conditions affecting up to 50 % of older patients, delirium is often unrecognized and overlooked. We examine the accuracy of the 4AT for detecting older patients with delirium.Methods: We performed a systematic search of PubMed, Web of Science, PsycINFO, and EMBASE databases from inception to April 2020 and updated to January 2022. Four independently reviewers extracted study data and assessed the methodological quality using the revised quality assessment of diagnostic accuracy studies tool (QUADAS-2). Pooled estimates of sensitivity and specificity were generated using a bivariate random effects model. All statistical analyses were performed with STATA version 15.1 and Meta-DiSc version 1.4 software. Results: Eleven studies with 2789 participants were included. The pooled sensitivity and specificity were 0.87 (95 % CI: 0.81-0.91) and 0.87 (95 % CI: 0.79-0.92), respectively, and the positive and negative likelihood ratios were 6.66 (95 % CI: 4.12-10.74) and 0.15 (95 % CI: 0.10-0.23), respectively. Deeks' test indicated no significant publication bias (t = 0.83, P = 0.43). Univariable meta-regression showed that patient selection and flow and timing significantly influenced the pooled sensitivity (P < 0.05), settings significantly influenced the pooled specificity (P < 0.05).Conclusion: Our meta-analysis demonstrates that 4AT is a sensitive and specific screening tool for delirium in older patients. Its brevity and simplicity support its use in routine clinical practice, particularly in time-poor settings. Clinicians should come to a conclusion based largely on the 4AT findings in conjunction with clinical judgment.
资助信息
the Central Universities (18LZUJBWZX006, 2019JBKYJC002);China Medical Board Open Project Funding (CMB 17-279); Special Fund for Soft Science in Gansu Province (18CX1ZA043).
资助机构
科研处
;
中国医学委员会
;
甘肃省科技厅
WOS关键词
METHODOLOGICAL QUALITY
;
COGNITIVE IMPAIRMENT
;
CARE
;
VALIDATION
;
INSTRUMENT
;
TESTS
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