🧠 4AT Rapid Delirium Screen
UseScore the four items at the bedside; sum them. A total ≥ 4 suggests possible delirium and triggers a search f…
SourceBellelli G, et al. Validation of the 4AT, a new instrument for rapid delirium screening. Age Ageing…
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
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Methodology · worked example, guidelines & full notes
Marked drowsiness/agitation or an acute fluctuating course each score 4, so either alone reaches the delirium threshold — reflecting their strong diagnostic weight. (original synthesis · not guideline verbatim)
When to use
Score the four items at the bedside; sum them. A total ≥ 4 suggests possible delirium and triggers a search for precipitants, while 1–3 suggests cognitive impairment.
How it works
4AT = alertness (0 or 4) + AMT4 errors (0/1/2) + attention months-backward (0/1/2) + acute change/fluctuation (0 or 4). Bands: ≥4 possible delirium · 1–3 possible cognitive impairment · 0 unlikely.
Key points
- Marked drowsiness/agitation or an acute fluctuating course each score 4, so either alone reaches the delirium threshold — reflecting their strong diagnostic weight. (original synthesis · not guideline verbatim)
- It needs no special training and takes under 2 minutes, making it suitable for routine screening at admission and on change in status.
- A positive screen warrants a precipitant search (infection, hypoxia, drugs, metabolic, pain, retention) and is not itself a diagnosis.
References
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Alertness | Normal |
|---|---|
| AMT4 (age, date of birth, place, year) | 1 error |
| Attention (months backward) | Starts but <7 or declines |
| Acute change or fluctuating course | Absent |
→4AT2pts
- Interpretation：Possible cognitive impairment
| Alertness | Normal |
|---|---|
| AMT4 (age, date of birth, place, year) | No errors |
| Attention (months backward) | Correctly states ≥7 months |
| Acute change or fluctuating course | Absent |
→4AT0pts
- Interpretation：Delirium/cognitive impairment unlikely
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using 4AT Rapid Delirium Screen?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does 4AT Rapid Delirium Screen upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is 4AT Rapid Delirium Screen calculated in practice? Can you show a worked example?
- Inputs: Alertness Normal, AMT4 (age, date of birth, place, year) 1 error, Attention (months backward) Starts but <7 or declines, Acute change or fluctuating course Absent → Result: 4AT 2 pts（Interpretation: Possible cognitive impairment） Inputs: Alertness Normal, AMT4 (age, date of birth, place, year) No errors, Attention (months backward) Correctly states ≥7 months, Acute change or fluctuating course Absent → Result: 4AT 0 pts（Interpretation: Delirium/cognitive impairment unlikely）