Diagnostic accuracy of the Spanish version of the 4AT scale (4AT-ES) for delirium screening in older inpatients

Background and objectivesThe 4AT scale is a sensitive tool for screening delirium, which can be applied rapidly in clinical settings without any specific training. It has not been translated, adapted, and validated to assess Spanish older adults. The aims of the study are: to translate and adapt to Spanish culture the 4AT scale, to present evidence of the diagnostic accuracy of this version (4AT-ES) when applied in non-specialized hospital wards, and to assess the loss of diagnostic accuracy in presence of risk factors.MethodsA prospective sample was independently assessed on the 4AT-ES and the reference standard. One hundred and twenty-one inpatients (70+ years) for whom a psychiatric assessment was requested were included. Out of them, 50 were diagnosed with delirium. Nurses without specific training applied the 4AT-ES, and experienced psychiatrists cast the reference standard diagnosis (DSM-V criteria).ResultsPatients with delirium were older and had more risk factors (more previous delirium episodes, a higher likelihood of prior dementia/cognitive impairment) than controls. The 4AT-ES had excellent validity, sensitivity (96%) , and specificity (83.1%). The area under the curve was 0.918; in the subsample with any of those risk factors, its value did not decrease.ConclusionThe 4AT-ES version of the 4AT scale was developed. When applied by non-specifically trained, nursing staff it showed excellent validity, sensitivity, and specificity, even in a subsample with previous risk factors. All indices were comparable to the original version. We recommend its use for efficient delirium screening in hospitalized older patients with suspected delirium. (AU)

Liaison psychiatry before and after the COVID-19 pandemic.

INTRODUCTION: the COVID-19 pandemic had an impact on hospital admissions. The clinical profiles of patients referred to liaison psychiatry teams (LPT) remained stable over the last few decades. We postulate changes in patient profiles due to the COVID-19 pandemic. MATERIALS AND METHODS: a total of 384 patients admitted to a tertiary care University Hospital in Madrid (Spain) and referred to LPTs were recruited. Patients referred 5 months before and after the first admission for COVID-19 were included. Clinical and sociodemographic characteristics were collected, and non-parametric hypothesis contrast tests were used to study possible differences between both periods. RESULTS: patients referred during the pandemic were significantly older (U = 2.006; p = .045), most of them were admitted to medical hospitalization units (χ2 (2) = 5.962; p = 015), and with a different reason for admission. There was an increase in the rate of adjustment disorders (χ2 (1) =7.893; p = 005) and delirium (χ2 (1) =9.413; p = 002), as well as psychiatric comorbidity (χ2 (2) = 9.930; p = .007), and a reduction in the proportion of patients treated for substance misuse (χ2 (5) = 19.152; p = .002). The number of deaths increased significantly (χ2 (1) = 6.611; p = .010). In persons over 65 years inappropriate prescription was significantly lower (χ2 (1) = 8.200; p = .004). CONCLUSIONS: the pandemic had an impact on the activity of the LPTs due to the change in the clinical profile and evolution of referred patients, maintaining standards of care that are reflected through prescription.