Shenkin SD, et al. - In this prospective diagnostic test accuracy study, researchers evaluated the accuracy of the 4 ‘A’s Test (4AT; a short delirium assessment tool designed for routine use without special training) for delirium detection, and compared the 4AT with another commonly used delirium assessment tool, the Confusion Assessment Method (CAM). The 4AT includes four items: Alertness, Abbreviated Mental Test-4, Attention (Months Backwards test), and acute change or fluctuating course. Study participants included acute medical patients aged ≥ 70 years. According to findings, the 4AT had a sensitivity of 76% and a specificity of 94% for delirium, as independently assessed by a reference standard. The area under the receiver operating characteristic curve was high at 0.90. The investigators also found that the CAM had a lower sensitivity than 4AT at 40%, with a higher specificity at 100%. The authors concluded that the 4AT is a short, pragmatic tool that can help improve delirium detection rates in clinical routine care.