4AT

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The 4 'A's Test (4AT) is a bedside medical scale used to help determine if a person has positive signs for delirium. [1] [2] The 4AT also includes cognitive test items, making it suitable also for use as a rapid test for cognitive impairment. [3]

Contents

The 4AT is designed to be used as a delirium detection tool in general clinical settings, inpatient hospital settings outside of the Intensive Care Unit (ICU), or in the community. The 4AT is intended to be used by healthcare practitioners without the need for special training, and it takes around two minutes to complete. [4] The test was first published online in 2011; the 4AT website provides downloads, and a guide to the test along with case examples. [4] The 4AT is also available as a standalone app on the Android and iOS platforms, and as an online calculator.

The 4AT has the most published diagnostic test accuracy data of any delirium tool, with >25 published studies involving >5000 observations. [5] It has been evaluated in multiple areas of practice including in the emergency department (ED), medical, surgical, community and palliative care settings. [6] [7] [8] The 4AT is used internationally in both clinical practice [9] [10] [11] [12] [13] [14] and research. [15] [16] [17] [18] It is recommended in clinical guidelines, including the UK NICE Guidelines on Delirium, and policy documents. [19] [20] [21] [22] [23] [24]

Some evidence shows that the 4AT can be implemented at scale in real-world clinical practice and that it shows positive score rates at comparable levels to the expected delirium prevalence rates. [25] [26]

A 2022 two-center study in real-world clinical populations (total N=82,770) found that 4AT positive scores were aligned with expected delirium rates, and also were strongly linked with important outcomes including 30-day mortality, one-year mortality, hospital length of stay, and days at home in the year following hospital admission. Notably, the 4AT was completed as part of usual care by a large number of different staff (mostly doctors and nurses) who had not received special training in use of the 4AT. This study therefore showed that the 4AT is feasible in large-scale practice and that it provides real-time delirium ascertainment with positive scores being linked to important short and longer-term outcomes. [26]

Summary

Full 4AT scale
Parameters and scoringPoints
[1] Alertness

This includes patients who may be markedly drowsy (eg. difficult to rouse

and/or obviously sleepyduring assessment) or agitated/hyperactive.

Observe the patient. If asleep, attempt to wake withspeech or a gentle touch

on the shoulder. Ask the patient to state their name and address to assist rating.

Normal (fully alert, but not agitated, throughout assessment)

Mild sleepiness for <10 seconds after waking, then normal

Clearly abnormal

0

0

4

[2] AMT4

Age, date of birth, place (name of the hospital or building), current year.

No mistakes

1 mistake

2 or more mistakes/untestable

0

1

2

[3] Attention

Ask the patient: "Please tell me the months of the year in backwards order,

starting at December."To assist initial understanding one prompt of "what is

the month before December?" is permitted.

Achieves 7 months or more correctly

Starts but scores <7 months / refuses to start

Untestable (cannot start because unwell, drowsy, inattentive)

0

1

2

[4] Acute change or fluctuating course

Evidence of significant change or fluctuation in alertness, cognition,other

mental function(eg. paranoia, hallucinations) arising over the last 2 weeks

and still evident in the last 24hrs

No

Yes

0

4

4AT TOTAL SCORE
SCORING KEY

4 or above: possible delirium +/- cognitive impairment

1-3: possible cognitive impairment

0: delirium or severe cognitive impairment unlikely

(Delirium still possible if [4] information incomplete)

The 4AT has 4 parameters:

  1. Alertness
  2. Abbreviated mental test-4 (AMT4)
  3. Attention (months backwards test)
  4. Acute change or fluctuating course

The score range is 0–12, with scores of 4 or more suggesting possible delirium. Scores of 1-3 suggest possible cognitive impairment.

There are several indications of a positive score of 4 or more. Parameters [1] and [4] can each individually trigger a positive score. The rationale is that both altered arousal and acute change in mental functioning are highly specific indicators of delirium. [27] [28] [29] [30]

Parameters [2] and [3] provide embedded cognitive testing. These parameters can also yield an overall positive score for the 4AT: if [2] scores as 2 or more mistakes or if the patient is untestable, and with [3] the patient is untestable, then the combined score is 4, suggesting possible delirium. The rationale for allowing untestability to trigger an outcome of possible delirium is that many people with delirium are too drowsy or inattentive to undergo cognitive testing or interview. [31] [30] These scoring options additionally allow the 4AT to be completed in patients who are unable to provide verbal responses.

Psychometric properties

A review of data to December 2019 involving 17 studies reported a pooled sensitivity of 88% and a pooled specificity of 88% for delirium diagnosis. [6] Since then, several additional validation studies have been published. [32] [33] [34] [35] [36] [37]

A large, high quality (STARD-compliant) diagnostic randomized controlled trial comparing the 4AT and the Confusion Assessment Method (CAM) found that the 4AT had higher sensitivity and similar specificity to the CAM. [38]

The 4AT is intended to be used to assess for delirium on initial presentation with the patient, in transitions of care, in periods of high risk such as post-operatively and when delirium is suspected. [39] Using the 4AT multiple times per day for monitoring for new onset delirium for prolonged periods (weeks or more) is not recommended because of the burden of repeated cognitive testing on patients and staff. [40] However, it can be used 1-2 times per day for specified periods, e.g. peri-operatively. Additionally the 4AT is commonly used to monitor for recovery from active delirium. The 4AT is thus considered an episodic delirium test rather than a monitoring test. Use of the 4AT multiple times per day may be associated with lower compliance and overall performance because of the burden on staff and patients caused by performing several face to face interviews and cognitive testing per day. [34] [41]

Shorter, largely observational tests such as the National Early Warning Score - 2 (NEWS2), [42] RADAR, [43] the Delirium Observation Scale (DOS), [44] the (Single Question in Delirium (SQiD)), [45] or the Nursing Delirium Screening Scale (Nu-DESC) [46] are more suitable for ongoing routine monitoring for new delirium after admission to hospital (or in long-term care settings). [47] A positive score in those tests generally then requires a more detailed assessment with a tool like the 4AT. This is an area of delirium practice which requires additional research.

The 4AT is one of several other delirium assessment tools in the literature. [48] Each varies in its intended use (research, severity grading, very brief screening, etc.), completion time, need for training, and psychometric characteristics. [49] [50] [51] [52] [2]

Languages

The 4AT has to date been translated into German, French, Italian, Spanish, Portuguese, Danish, Finnish, Swedish, Turkish, Arabic, Norwegian, Thai, Cantonese, Putonghua, Russian, Korean, Japanese, and Icelandic. [39]

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References

  1. ↑ Delirium Archived 2019-05-13 at the Wayback Machine , Symptom Finder online.
  2. 1 2 Wilson, Jo Ellen; Mart, Matthew F.; Cunningham, Colm; Shehabi, Yahya; Girard, Timothy D.; MacLullich, Alasdair M. J.; Slooter, Arjen J. C.; Ely, E. Wesley (2020-11-12). "Delirium". Nature Reviews. Disease Primers. 6 (1): 90. doi: 10.1038/s41572-020-00223-4 . ISSN   2056-676X. PMC   9012267 . PMID   33184265.
  3. ↑ Calf, Agneta H.; Pouw, Maaike A.; van Munster, Barbara C.; Burgerhof, Johannes G. M.; de Rooij, Sophia E.; Smidt, Nynke (2021-01-08). "Screening instruments for cognitive impairment in older patients in the Emergency Department: a systematic review and meta-analysis". Age and Ageing. 50 (1): 105–112. doi:10.1093/ageing/afaa183. ISSN   1468-2834. PMC   7793600 . PMID   33009909.
  4. 1 2 "4AT – RAPID CLINICAL TEST FOR DELIRIUM" . Retrieved 14 May 2020.
  5. ↑ "References". 4AT - RAPID CLINICAL TEST FOR DELIRIUM. Retrieved 2022-02-26.
  6. 1 2 Tieges, Zoë; Maclullich, Alasdair M. J.; Anand, Atul; Brookes, Claire; Cassarino, Marica; O'connor, Margaret; Ryan, Damien; Saller, Thomas; Arora, Rakesh C.; Chang, Yue; Agarwal, Kathryn (2020-11-11). "Diagnostic accuracy of the 4AT for delirium detection in older adults: systematic review and meta-analysis". Age and Ageing. 50 (3): 733–743. doi: 10.1093/ageing/afaa224 . ISSN   1468-2834. PMC   8099016 . PMID   33196813.
  7. ↑ Shenkin, Susan D.; Fox, Christopher; Godfrey, Mary; Siddiqi, Najma; Goodacre, Steve; Young, John; Anand, Atul; Gray, Alasdair; Hanley, Janet; MacRaild, Allan; Steven, Jill (2019-07-24). "Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method". BMC Medicine. 17 (1): 138. doi: 10.1186/s12916-019-1367-9 . ISSN   1741-7015. PMC   6651960 . PMID   31337404.
  8. ↑ Arnold, Elizabeth; Finucane, Anne M; Taylor, Stacey; Spiller, Juliet A; O’Rourke, Siobhan; Spenceley, Julie; Carduff, Emma; Tieges, Zoë; MacLullich, Alasdair MJ (May 2024). "The 4AT, a rapid delirium detection tool for use in hospice inpatient units: Findings from a validation study". Palliative Medicine. 38 (5): 535–545. doi:10.1177/02692163241242648. ISSN   0269-2163. PMC   11170929 .
  9. ↑ "National Audit of Dementia Reports and Resources". RC PSYCH ROYAL COLLEGE OF PSYCHIATRISTS. Retrieved 14 May 2020.
  10. ↑ "National Hip Fracture Database: Annual Report 2019" (PDF). National Hip Fracture Database. Retrieved 14 May 2020.
  11. ↑ MacLullich, AM; Shenkin, SD; Goodacre, S; Godfrey, M; Hanley, J; Stíobhairt, A; Lavender, E; Boyd, J; Stephen, J; Weir, C; MacRaild, A; Steven, J; Black, P; Diernberger, K; Hall, P; Tieges, Z; Fox, C; Anand, A; Young, J; Siddiqi, N; Gray, A (August 2019). "The 4 'A's test for detecting delirium in acute medical patients: a diagnostic accuracy study". Health Technology Assessment. 23 (40): 1–194. doi:10.3310/hta23400. PMC   6709509 . PMID   31397263.
  12. ↑ Dormandy, L; Mufti, S; Higgins, E; Bailey, C; Dixon, M (October 2019). "Shifting the focus: A QI project to improve the management of delirium in patients with hip fracture". Future Healthcare Journal. 6 (3): 215–219. doi:10.7861/fhj.2019-0006. PMC   6798014 . PMID   31660529.
  13. ↑ Bearn, A; Lea, W; Kusznir, J (29 November 2018). "Improving the identification of patients with delirium using the 4AT assessment". Nursing Older People. 30 (7): 18–27. doi:10.7748/nop.2018.e1060. PMID   30426731. S2CID   53303149.
  14. ↑ E, Vardy; N, Collins; U, Grover; R, Thompson; A, Bagnall; G, Clarke; S, Heywood; B, Thompson; L, Wintle (2020-05-16). "Use of a Digital Delirium Pathway and Quality Improvement to Improve Delirium Detection in the Emergency Department and Outcomes in an Acute Hospital". Age and Ageing. 49 (4): 672–678. doi: 10.1093/ageing/afaa069 . PMID   32417926.
  15. ↑ Casey, P; Cross, W; Mart, MW; Baldwin, C; Riddell, K; Dārziņš, P (March 2019). "Hospital discharge data under-reports delirium occurrence: results from a point prevalence survey of delirium in a major Australian health service". Internal Medicine Journal. 49 (3): 338–344. doi:10.1111/imj.14066. PMID   30091294. S2CID   205209486.
  16. ↑ Bellelli, PG; Biotto, M; Morandi, A; Meagher, D; Cesari, M; Mazzola, P; Annoni, G; Zambon, A (December 2019). "The relationship among frailty, delirium and attentional tests to detect delirium: a cohort study". European Journal of Internal Medicine. 70: 33–38. doi:10.1016/j.ejim.2019.09.008. PMID   31761505. S2CID   208277203.
  17. ↑ Bellelli, G; Morandi, A; Di Santo, SG; Mazzone, A; Cherubini, A; Mossello, E; Bo, M; Bianchetti, A; Rozzini, R; Zanetti, E; Musicco, M; Ferrari, A; Ferrara, N; Trabucchi, M; Italian Study Group on Delirium, (ISGoD). (18 July 2016). ""Delirium Day": a nationwide point prevalence study of delirium in older hospitalized patients using an easy standardized diagnostic tool". BMC Medicine. 14: 106. doi: 10.1186/s12916-016-0649-8 . PMC   4950237 . PMID   27430902.
  18. ↑ Davis, D; Richardson, S; Hornby, J; Bowden, H; Hoffmann, K; Weston-Clarke, M; Green, F; Chaturvedi, N; Hughes, A; Kuh, D; Sampson, E; Mizoguchi, R; Cheah, KL; Romain, M; Sinha, A; Jenkin, R; Brayne, C; MacLullich, A (9 February 2018). "The delirium and population health informatics cohort study protocol: ascertaining the determinants and outcomes from delirium in a whole population". BMC Geriatrics. 18 (1): 45. doi: 10.1186/s12877-018-0742-2 . PMC   5807842 . PMID   29426299.
  19. ↑ "SIGN 157 Delirium: Risk reduction and management of delirium". www.sign.ac.uk. Retrieved 14 May 2020.
  20. ↑ "Delirium Clinical Care Standard" (PDF). Australian Commission on Safety and Quality in Health Care. Retrieved 14 May 2020.
  21. ↑ "National Early Warning Score (NEWS) 2. Standardising the assessment of acute-illness severity in the NHS. Additional Implementation Guidance March 2020" . Retrieved 2 June 2020.
  22. ↑ "Delirium Quality Standard: Tools for Implementation". Quorum. Retrieved 2021-05-13.
  23. ↑ "Integrated Care Pathways and Delirium Algorithms". dementiapathways.ie. Retrieved 2021-05-13.
  24. ↑ "4AT calculator". www.signdecisionsupport.uk. Retrieved 2021-05-13.
  25. ↑ Penfold, Rose S.; Squires, Charlotte; Angus, Alisa; Shenkin, Susan D.; Ibitoye, Temi; Tieges, Zoë; Neufeld, Karin J.; Avelino‐Silva, Thiago J.; Davis, Daniel; Anand, Atul; Duckworth, Andrew D.; Guthrie, Bruce; MacLullich, Alasdair M. J. (2024-01-19). "Delirium detection tools show varying completion rates and positive score rates when used at scale in routine practice in general hospital settings: A systematic review". Journal of the American Geriatrics Society. doi: 10.1111/jgs.18751 . ISSN   0002-8614.
  26. 1 2 Anand, Atul; Cheng, Michael; Ibitoye, Temi; Maclullich, Alasdair M J; Vardy, Emma R L C (2022-03-01). "Positive scores on the 4AT delirium assessment tool at hospital admission are linked to mortality, length of stay and home time: two-centre study of 82,770 emergency admissions". Age and Ageing. 51 (3): afac051. doi:10.1093/ageing/afac051. ISSN   0002-0729. PMC   8923813 . PMID   35292792.
  27. ↑ Inouye, S. K.; van Dyck, C. H.; Alessi, C. A.; Balkin, S.; Siegal, A. P.; Horwitz, R. I. (1990-12-15). "Clarifying confusion: the confusion assessment method. A new method for detection of delirium". Annals of Internal Medicine. 113 (12): 941–948. doi:10.7326/0003-4819-113-12-941. ISSN   0003-4819. PMID   2240918.
  28. ↑ Tieges, Zoë; McGrath, Aisling; Hall, Roanna J.; Maclullich, Alasdair M. J. (December 2013). "Abnormal level of arousal as a predictor of delirium and inattention: an exploratory study". The American Journal of Geriatric Psychiatry. 21 (12): 1244–1253. doi:10.1016/j.jagp.2013.05.003. ISSN   1545-7214. PMID   24080383.
  29. ↑ Chester, Jennifer G.; Beth Harrington, Mary; Rudolph, James L.; VA Delirium Working Group (May 2012). "Serial administration of a modified Richmond Agitation and Sedation Scale for delirium screening". Journal of Hospital Medicine. 7 (5): 450–453. doi:10.1002/jhm.1003. ISSN   1553-5606. PMC   4880479 . PMID   22173963.
  30. 1 2 European Delirium Association; American Delirium Society (2014-10-08). "The DSM-5 criteria, level of arousal and delirium diagnosis: inclusiveness is safer". BMC Medicine. 12: 141. doi: 10.1186/s12916-014-0141-2 . ISSN   1741-7015. PMC   4177077 . PMID   25300023.
  31. ↑ Yates, Catherine; Stanley, Neil; Cerejeira, Joaquim M.; Jay, Roger; Mukaetova-Ladinska, Elizabeta B. (March 2009). "Screening instruments for delirium in older people with an acute medical illness". Age and Ageing. 38 (2): 235–237. doi: 10.1093/ageing/afn285 . hdl: 10400.4/1170 . ISSN   1468-2834. PMID   19110484.
  32. ↑ Hasegawa, Tadashi; Seo, Tomomi; Kubota, Yoko; Sudo, Tomoko; Yokota, Kumi; Miyazaki, Nao; Muranaka, Akira; Hirano, Shigeki; Yamauchi, Atsushi; Nagashima, Kengo; Iyo, Masaomi (January 2022). "Reliability and validity of the Japanese version of the 4A's Test for delirium screening in the elderly patient". Asian Journal of Psychiatry. 67: 102918. doi:10.1016/j.ajp.2021.102918. ISSN   1876-2026. PMID   34798384. S2CID   243841870.
  33. ↑ Johansson, Yvonne A.; Tsevis, Theofanis; Nasic, Salmir; Gillsjö, Catharina; Johansson, Linda; Bogdanovic, Nenad; Kenne Sarenmalm, Elisabeth (2021-10-18). "Diagnostic accuracy and clinical applicability of the Swedish version of the 4AT assessment test for delirium detection, in a mixed patient population and setting". BMC Geriatrics. 21 (1): 568. doi: 10.1186/s12877-021-02493-3 . ISSN   1471-2318. PMC   8522056 . PMID   34663229.
  34. 1 2 Chang, Yue; Ragheb, Sandra M.; Oravec, Nebojsa; Kent, David; Nugent, Kristina; Cornick, Alexandra; Hiebert, Brett; Rudolph, James L.; MacLullich, Alasdair M. J.; Arora, Rakesh C. (2021-06-01). "Diagnostic accuracy of the "4 A's Test" delirium screening tool for the postoperative cardiac surgery ward". The Journal of Thoracic and Cardiovascular Surgery. 165 (3): S0022–5223(21)00876–X. doi:10.1016/j.jtcvs.2021.05.031. hdl: 20.500.11820/a4b90ba6-dd24-428b-b038-df1670781523 . ISSN   1097-685X. PMID   34243932. S2CID   235786438.
  35. ↑ Delgado-Parada, E.; Morillo-Cuadrado, D.; Saiz-Ruiz, J; Cebollada-Gracia, A.; Ayuso-Mateos, J. L.; Cruz-Jentoft, A. J. (2022-02-10). "Diagnostic accuracy of the Spanish version of the 4AT scale (4AT-ES) for delirium screening in older inpatients". The European Journal of Psychiatry. 36 (3): 182–190. doi:10.1016/j.ejpsy.2022.01.003. ISSN   0213-6163. S2CID   246767623.
  36. ↑ Evensen, Sigurd; Hylen Ranhoff, Anette; Lydersen, Stian; Saltvedt, Ingvild (August 2021). "The delirium screening tool 4AT in routine clinical practice: prediction of mortality, sensitivity and specificity". European Geriatric Medicine. 12 (4): 793–800. doi:10.1007/s41999-021-00489-1. ISSN   1878-7649. PMC   8321971 . PMID   33813725.
  37. ↑ Sepúlveda, Esteban; Bermúdez, Ester; González, Dulce; Cotino, Paula; Viñuelas, Eva; Palma, José; Ciutat, Marta; Grau, Imma; Vilella, Elisabet; Trzepacz, Paula T.; Franco, José G. (May 2021). "Validation of the Delirium Diagnostic Tool-Provisional (DDT-Pro) in a skilled nursing facility and comparison to the 4 'A's test (4AT)". General Hospital Psychiatry. 70: 116–123. doi:10.1016/j.genhosppsych.2021.03.010. ISSN   1873-7714. PMID   33813146. S2CID   233029095.
  38. ↑ Shenkin, Susan D.; Fox, Christopher; Godfrey, Mary; Siddiqi, Najma; Goodacre, Steve; Young, John; Anand, Atul; Gray, Alasdair; Hanley, Janet; MacRaild, Allan; Steven, Jill (2019-07-24). "Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method". BMC Medicine. 17 (1): 138. doi: 10.1186/s12916-019-1367-9 . ISSN   1741-7015. PMC   6651960 . PMID   31337404.
  39. 1 2 "4AT – RAPID CLINICAL TEST FOR DELIRIUM" . Retrieved 2020-05-14.
  40. ↑ "Delirium detection in routine clinical care: two basic processes". DeliriumWords.com. 15 June 2020. Retrieved 2021-05-13.
  41. ↑ Zastrow, Inke; Tohsche, Peter; Loewen, Theresa; Vogt, Birgit; Feige, Melanie; Behnke, Martina; Wolff, Antje; Kiefmann, Rainer; Olotu, Cynthia (2021-09-01). "Comparison of the '4-item assessment test' and 'nursing delirium screening scale' delirium screening tools on non-intensive care unit wards: A prospective mixed-method approach". European Journal of Anaesthesiology. 38 (9): 957–965. doi:10.1097/EJA.0000000000001470. ISSN   1365-2346. PMID   33606422. S2CID   231964159.
  42. ↑ "NEWS2: Additional implementation guidance". RCP London. 2020-04-06. Retrieved 2020-06-18.
  43. ↑ Voyer, Philippe; Champoux, Nathalie; Desrosiers, Johanne; Landreville, Philippe; McCusker, Jane; Monette, Johanne; Savoie, Maryse; Richard, Sylvie; Carmichael, Pierre-Hugues (2015). "Recognizing acute delirium as part of your routine [RADAR]: a validation study". BMC Nursing. 14: 19. doi: 10.1186/s12912-015-0070-1 . ISSN   1472-6955. PMC   4384313 . PMID   25844067.
  44. ↑ Schuurmans, Marieke J.; Shortridge-Baggett, Lillie M.; Duursma, Sijmen A. (2003). "The Delirium Observation Screening Scale: a screening instrument for delirium". Research and Theory for Nursing Practice. 17 (1): 31–50. doi:10.1891/rtnp.17.1.31.53169. ISSN   1541-6577. PMID   12751884. S2CID   219203272.
  45. ↑ Sands, M. B.; Dantoc, B. P.; Hartshorn, A.; Ryan, C. J.; Lujic, S. (September 2010). "Single Question in Delirium (SQiD): testing its efficacy against psychiatrist interview, the Confusion Assessment Method and the Memorial Delirium Assessment Scale". Palliative Medicine. 24 (6): 561–565. doi:10.1177/0269216310371556. ISSN   1477-030X. PMID   20837733. S2CID   40306973.
  46. ↑ Hargrave, Anita; Bastiaens, Jesse; Bourgeois, James A.; Neuhaus, John; Josephson, S. Andrew; Chinn, Julia; Lee, Melissa; Leung, Jacqueline; Douglas, Vanja (November 2017). "Validation of a Nurse-Based Delirium-Screening Tool for Hospitalized Patients". Psychosomatics. 58 (6): 594–603. doi:10.1016/j.psym.2017.05.005. ISSN   1545-7206. PMC   5798858 . PMID   28750835.
  47. ↑ "Delirium detection in routine clinical care: two basic processes". DeliriumWords.com. 15 June 2020. Retrieved 2021-01-12.
  48. ↑ "A classification of delirium assessment tools". DeliriumWords.com. 13 July 2020. Retrieved 2020-11-28.
  49. ↑ De, J; Wand, AP (December 2015). "Delirium Screening: A Systematic Review of Delirium Screening Tools in Hospitalized Patients". The Gerontologist. 55 (6): 1079–99. doi: 10.1093/geront/gnv100 . PMID   26543179.
  50. ↑ Pérez-Ros, P; Martínez-Arnau, FM (30 January 2019). "Delirium Assessment in Older People in Emergency Departments. A Literature Review". Diseases. 7 (1): 14. doi: 10.3390/diseases7010014 . PMC   6473718 . PMID   30704024.
  51. ↑ Rieck, KM; Pagali, S; Miller, DM (March 2020). "Delirium in hospitalized older adults". Hospital Practice (1995). 48 (sup1): 3–16. doi:10.1080/21548331.2019.1709359. PMID   31874064. S2CID   209474088.
  52. ↑ "Adult Delirium Measurement Info Cards – NIDUS" . Retrieved 14 May 2020.
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