Delirium is a common and distressing condition manifesting as an acute decline of attention and cognition. It isassociated with a wide range of adverse patient safety outcomes, yet it remains consistently under-diagnosed and treated inappropriately. Delirium continues to be recognized as a patient management challenge in medical inpatients, notably those presenting to the Emergency Department. There is an ever growing need to understand and improve the current assessment practices of delirium to avoid adverse patient outcomes in older adults.
The 4 ‘A’s Test or 4AT was developed as a short (<2 minute) delirium assessment tool intended for clinical use in general settings at first presentation and when delirium is suspected. The National Institute for Health and Care Excellence (NICE) Guidelines recommend that all patients aged 65 or over are screened for delirium upon hospital admission using the 4AT. We intend to perform a systematic review and meta-analysis of studies that have evaluated the diagnostic test accuracy of the 4AT for delirium detection in older adults in an Emergency Department setting. Inclusion criteria will include older adults (≥65 years); diagnostic accuracy study of the 4AT index test when compared to delirium reference standard (standard diagnostic criteria or validated tool). Methodological quality will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled estimates of sensitivity and specificity will be generated from a bivariate random effects model to demonstrate diagnostic test accuracy.