{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:37:58Z","timestamp":1790300278964,"version":"4.1.0"},"reference-count":45,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinics and Practice"],"abstract":"<jats:p>Background: Delirium is a frequent and serious complication in elderly patients with hip fractures and is associated with adverse outcomes. Early identification requires a brief and reliable screening tool suitable for routine clinical practice. The 4 \u2018A\u2019s Test (4AT) is a rapid instrument for delirium detection that requires minimal training. Objective: To translate, culturally adapt, and validate the Greek version of the 4AT in elderly patients with hip fractures. Methods: A total of 103 patients aged \u226565 years who were admitted with hip fracture were enrolled. The 4AT was translated using a forward\u2013backward translation process and culturally adapted according to established guidelines. Delirium diagnosis was established using DSM-5 criteria by trained clinicians, serving as the reference standard. The 4AT was administered independently within 3 h. Diagnostic accuracy was assessed by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC). The optimal cut-off was determined using Youden\u2019s index. Results: At a cut-off score \u22654, the Greek 4AT demonstrated a sensitivity of 87.5% and specificity of 91.1%, with PPV 75% and NPV 96%. The AUC was 0.94, indicating excellent diagnostic performance. Conclusions: The Greek version of the 4AT is a valid and reliable screening tool for detecting delirium in elderly patients with hip fractures.<\/jats:p>","DOI":"10.3390\/clinpract16030058","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T11:06:52Z","timestamp":1773054412000},"page":"58","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Translation, Cultural Adaptation, and Validation of the Greek Version of the 4 \u2018A\u2019s Test for Delirium Screening in Elderly Patients with Hip Fracture"],"prefix":"10.3390","volume":"16","author":[{"given":"Maria","family":"Spyraki","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4715-5079","authenticated-orcid":false,"given":"Evanthia","family":"Dimitriou","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1682-662X","authenticated-orcid":false,"given":"Panagiotis","family":"Antzoulas","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4163-9148","authenticated-orcid":false,"given":"Georgios","family":"Karpetas","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7198-2628","authenticated-orcid":false,"given":"Francesk","family":"Mulita","sequence":"additional","affiliation":[{"name":"Department of Surgery, General Hospital of Aigio, 25100 Aigio, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8692-0059","authenticated-orcid":false,"given":"Vasileios","family":"Leivaditis","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic and Vascular Surgery, Westpfalz Klinikum, 67655 Kaiserslautern, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ejona","family":"Shaska","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, \u201cAli Mihali\u201d Psychiatric Hospital, 9401 Vlora, Albania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Lakoumentas","sequence":"additional","affiliation":[{"name":"Department of Medical Physics, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4900-2456","authenticated-orcid":false,"given":"Diamanto","family":"Aretha","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8215-9327","authenticated-orcid":false,"given":"Andreas","family":"Panagopoulos","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, General University Hospital of Patras, 26504 Patras, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Soler-Sanchis, A., Mart\u00ednez-Arnau, F.M., S\u00e1nchez-Frutos, J., and P\u00e9rez-Ros, P. 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