Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis: a prospective cohort study

• Published in: European geriatric medicine 2022-02, Vol.13 (1), p.155-162
• Main Authors: Myrstad, Marius, Kuwelker, Kanika, Haakonsen, Sigurd, Valebjørg, Therese, Langeland, Nina, Kittang, Bård Reiakvam, Hagberg, Guri, Neerland, Bjørn Erik, Bakken, Marit Stordal
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Delirium - diagnosis; Delirium - epidemiology; Emergency Service, Hospital; Female; Geriatrics/Gerontology; Humans; Internal Medicine; Male; Medicine; Medicine & Public Health; Prospective Studies; Research Paper; Retrospective Studies; Sepsis - diagnosis; Sepsis - epidemiology
• ISSN: 1878-7649; 1878-7657; 1878-7657
• DOI: 10.1007/s41999-021-00558-5

Key summary points Aim To study delirium screening upon Emergency Department admission among patients admitted with suspected sepsis. Findings Delirium screening upon Emergency Department admission, using 4AT, was useful among patients aged ≥65 years admitted with suspected sepsis. Two out of three patients had at least one feature of delirium upon admission. Message This study suggest increased awareness of delirium among older patients with suspected sepsis. Purpose We aimed to study the use of The 4 ‘A’s test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission, and to characterize older patients admitted to the ED with and without sepsis in terms of delirium features. Methods In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the ED with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. Results Out of the 196 patients included (mean age 81 years, 60% men), 100 patients fulfilled the sepsis diagnosis criteria. The mean 4AT screening time was 2.5 Minutes. In total, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p