Journal article
Clinical Utility and Performance of the Traditional Chinese Version of the 4-As Test for Delirium due to Traumatic Brain Injury
Journal of the Academy of Consultation-Liaison Psychiatry, Vol.66(2), pp.130-138
2025
PMID: 39761830
Abstract
Background:
Delirium is a common symptom following a traumatic brain injury that is often overlooked by healthcare professionals. Early detection of posttraumatic delirium is crucial to improving patient outcomes and quality of life. The 4 As Test (4AT: alertness, attention, abbreviated mental test-4, and acute mental changes) is a brief and rapid tool for delirium assessment with acceptable reliability and validity. However, the 4AT has not yet been translated for use in the Taiwanese population.
Objective:
To translate the 4AT into Traditional Chinese (TC-4AT), assess its reliability and validity, and explore the clinical effects of delirium in patients with a traumatic brain injury.
Methods:
This prospective observational study was conducted at the neurosurgery wards of 2 Taiwanese hospitals. Patients who were aged 20 years or older, were diagnosed with a traumatic brain injury, and had a Glasgow Coma Scale score between 13 and 15 were included. Interrater reliability was assessed, and validity was verified using criterion-related comparisons with the Short Confusion Assessment Method. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria were employed to assess the sensitivity and specificity of the TC-4AT for screening posttraumatic brain injury delirium.
Results:
A total of 100 patients with an average age of 67 years were enrolled, of whom 10% were diagnosed with delirium based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. The interrater reliability of the TC-4AT was 1.00. Patients with delirium tended to have a longer hospital stay than those without delirium (13 days vs. 7 days) although the difference was nonsignificant (P = 0.28). In terms of criterion validity, patients diagnosed with delirium using the Short Confusion Assessment Method had a significantly higher score on the TC-4AT than those not diagnosed with delirium (P < 0.001). The receiver operating characteristic curve indicated that the optimal cutoff point was 4, with sensitivity, specificity, and area under the characteristic curve of 0.90, 0.94, and 0.96, respectively.
Conclusion:
The TC-4AT is an accurate tool for delirium assessment that aids early detection and in informed decision-making in preventive care.
Details
- Title
- Clinical Utility and Performance of the Traditional Chinese Version of the 4-As Test for Delirium due to Traumatic Brain Injury
- Authors
- Yun-Hsuan Lai (Author) - Taipei Medical UniversityChia-Jou Lin (Author) - Taipei Medical UniversityI-Chang Su (Author) - Taipei Medical UniversitySheng-Wen Huang (Author) - Taipei Medical UniversityChia-Chi Hsiao (Author) - Taipei Medical UniversityYing-Ling Jao (Author) - Pennsylvania State UniversityPin-Yuan Chen (Author) - Chang Gung Memorial HospitalVictoria Traynor - University of the Sunshine Coast, Queensland, School of Health - NursingChuan-Ya Lee (Author) - Taipei Medical UniversityTing-Jhen Chen (Author) - Taipei Medical UniversityMu-Hsing Ho (Author) - University of WollongongHsiao-Yean Chiu (Corresponding Author) - Taipei Medical University
- Publication details
- Journal of the Academy of Consultation-Liaison Psychiatry, Vol.66(2), pp.130-138
- Publisher
- Elsevier Inc.
- Date published
- 2025
- DOI
- 10.1016/j.jaclp.2024.12.005
- ISSN
- 2667-2960
- PMID
- 39761830
- Data Availability
- The data that support the findings of this study are available from the corresponding author, HYC, upon reasonable request.
- Grant note
- This study was supported by grants awarded to HYC by the National Science and Technology Council, Taiwan (NSTC 112-2628-B-038-003 and NSTC 111-2314-B-038-033-MY3.).
- Organisation Unit
- School of Health - Nursing
- Language
- English
- Record Identifier
- 991125706102621
- Output Type
- Journal article
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