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4AT (Rapid Assessment Test for Delirium)

4AT: A rapid bedside assessment for delirium. Crucially, score patients who are "untestable" due to drowsiness or severe agitation, as this often indicates delirium.

Select the best option for each item

1. Alertness

2. AMT4 (Age, DOB, Place, Year)

3. Attention (Months backwards)

4. Acute Change or Fluctuating Course

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

Rapid delirium screening in the emergency department, acute medical units, and surgical wards.

Initial assessment of older adults presenting with acute confusion, falls, or functional decline.

Settings where a rapid (<2 minute) tool is needed without requiring special training.

Assessment of patients who are too drowsy or agitated to complete longer cognitive tests.

Why the 4AT?

The 4AT is designed for rapid clinical use. Unlike the CAM, it incorporates a brief cognitive test (AMT4) directly into the tool and explicitly scores untestable patients (who are often delirious). It is endorsed by SIGN and NICE guidelines as a primary delirium screen.

Related Scores in Practice

In clinical practice, this assessment is frequently evaluated alongside other validated measures. Depending on the patient's presentation and specific diagnostic requirements, you may also need to utilize the CAM — Confusion Assessment Method, DOSS (Delirium Observation Screening Scale), DRS-R-98 (Delirium Rating Scale) or the Sqid Delirium to formulate a comprehensive care plan.

Last Comprehensive Review: 2026

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CAM — Confusion Assessment Method

ACS-NSQIP Surgical Risk Calculator

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Edmonton Frail Scale

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