{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T06:36:21Z","timestamp":1793255781166,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2024,5,1]],"date-time":"2024-05-01T00:00:00Z","timestamp":1714521600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000654","name":"Marie Curie","doi-asserted-by":"publisher","award":["Small research grant"],"award-info":[{"award-number":["Small research grant"]}],"id":[{"id":"10.13039\/501100000654","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat Med"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Delirium is a serious neuropsychiatric syndrome with adverse outcomes, which is common but often undiagnosed in terminally ill people. The 4 \u2018A\u2019s test or 4AT ( www.the4AT.com ), a brief delirium detection tool, is widely used in general settings, but validation studies in terminally ill people are lacking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To determine the diagnostic accuracy of the 4AT in detecting delirium in terminally ill people, who are hospice inpatients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A diagnostic test accuracy study in which participants underwent the 4AT and a reference standard based on the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders. The reference standard was informed by Delirium Rating Scale Revised-98 and tests assessing arousal and attention. Assessments were conducted in random order by pairs of independent raters, blinded to the results of the other assessment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting\/participants:<\/jats:title>\n                    <jats:p>Two hospice inpatient units in Scotland, UK. Participants were 148 hospice inpatients aged \u2a7e18\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 137 participants completed both assessments. Three participants had an indeterminate reference standard diagnosis and were excluded, yielding a final sample of 134. Mean age was 70.3 (SD\u2009=\u200910.6) years. About 33% (44\/134) had reference standard delirium. The 4AT had a sensitivity of 89% (95% CI 79%\u201398%) and a specificity of 94% (95% CI 90%\u201399%). The area under the receiver operating characteristic curve was 0.97 (95% CI 0.94\u20131).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>The results of this validation study support use of the 4AT as a delirium detection tool in hospice inpatients, and add to the literature evaluating methods of delirium detection in palliative care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registry:<\/jats:title>\n                    <jats:p>ISCRTN 97417474.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692163241242648","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T07:48:10Z","timestamp":1716191290000},"page":"535-545","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":9,"title":["The 4AT, a rapid delirium detection tool for use in hospice inpatient units: Findings from a validation study"],"prefix":"10.1177","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4930-9397","authenticated-orcid":false,"given":"Elizabeth","family":"Arnold","sequence":"first","affiliation":[{"name":"Marie Curie Hospice Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3056-059X","authenticated-orcid":false,"given":"Anne M","family":"Finucane","sequence":"additional","affiliation":[{"name":"Marie Curie Hospice Edinburgh, Edinburgh, UK"},{"name":"Clinical Psychology, University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stacey","family":"Taylor","sequence":"additional","affiliation":[{"name":"Marie Curie Hospice Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet A","family":"Spiller","sequence":"additional","affiliation":[{"name":"Marie Curie Hospice Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siobhan","family":"O\u2019Rourke","sequence":"additional","affiliation":[{"name":"Marie Curie Hospice Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Spenceley","sequence":"additional","affiliation":[{"name":"Marie Curie Hospice Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Carduff","sequence":"additional","affiliation":[{"name":"Marie Curie Hospice Glasgow, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00eb","family":"Tieges","sequence":"additional","affiliation":[{"name":"Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK"},{"name":"Department of Computing, School of Computing, Engineering and Built Environment, Glasgow Caledonian University, Scotland, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alasdair MJ","family":"MacLullich","sequence":"additional","affiliation":[{"name":"Edinburgh Delirium Research Group, Ageing and Health, Usher Institute, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,5,20]]},"reference":[{"key":"bibr1-02692163241242648","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596"},{"key":"bibr2-02692163241242648","doi-asserted-by":"publisher","DOI":"10.1177\/0269216319854944"},{"key":"bibr3-02692163241242648","doi-asserted-by":"publisher","DOI":"10.1093\/jjco\/hym155"},{"key":"bibr4-02692163241242648","doi-asserted-by":"publisher","DOI":"10.1191\/0269216306pm1097oa"},{"key":"bibr5-02692163241242648","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2013.0646"},{"key":"bibr6-02692163241242648","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-013-0365-4"},{"key":"bibr7-02692163241242648","doi-asserted-by":"publisher","DOI":"10.3390\/cancers13235893"},{"key":"bibr8-02692163241242648","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-020-00223-4"},{"key":"bibr9-02692163241242648","unstructured":"Scottish Palliative Care Guidelines. https:\/\/www.palliativecareguidelines.scot.nhs.uk\/guidelines\/symptom-control\/delirium.aspx (2020, accessed 25 January 2023)."},{"key":"bibr10-02692163241242648","unstructured":"Scottish Intercollegiate Guidelines Network. 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