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

Atul Anand, Michael Cheng, Temi Ibitoye, Alasdair M J MacLullich, Emma Rachael Louise Cunningham Vardy

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Studies investigating outcomes of delirium using large-scale routine data are rare. We performed a two-centre study using the 4 ‘A’s Test (4AT) delirium detection tool to analyse relationships between delirium and 30-day mortality, length of stay, and home time (days at home in the year following admission).
Methods
The 4AT was performed as part of usual care. Data from emergency admissions in patients ≥65 years in Lothian (n=43,946) and Salford (n=38,824) over a period of approximately 3 years were analysed using logistic regression models adjusted for age and sex.
Results
4AT completion rates were 77% in Lothian and 49% in Salford. 4AT scores indicating delirium (≥4/12) were present in 25% of patients in Salford, and 18% in Edinburgh. 30-day mortality with 4AT ≥4 was 5.5-fold greater than the 4AT 0/12 group in Edinburgh (adjusted odds ratio (aOR) 5.53, 95% confidence interval [CI] 4.99–6.13) and 3.4-fold greater in Salford (aOR 3.39, 95% CI 2.98–3.87). Length of stay was more than double in patients with 4AT scores of 1-3/12 (indicating cognitive impairment) or ≥4/12 compared to 4AT 0/12. Median home time at 1 year was reduced by 112 days (Edinburgh) and 61 days (Salford) in the 4AT ≥4 group (p<0.001).
Conclusions
Scores on the 4AT used at scale in practice are strongly linked with 30-day mortality, length of hospital stay and home time. The findings highlight the need for better understanding of why delirium is linked with poor outcomes and also the need to improve delirium detection and treatment.
Original languageEnglish
JournalAge and Ageing
Volume51
Issue number3
DOIs
Publication statusPublished - 16 Mar 2022

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