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Objective: to evaluate the performance of the 4 ‘A’s Test (4AT) in screening for delirium in older patients. The 4AT is a new test for rapid screening of delirium in routine clinical practice.

Design: prospective study of consecutively admitted elderly patients with independent 4AT and reference standard assessments.

Setting: an acute geriatrics ward and a department of rehabilitation.

Participants: two hundred and thirty-six patients (aged ≥70 years) consecutively admitted over a period of 4 months.

Measurements: in each centre, the 4AT was administered by a geriatrician to eligible patients within 24 h of admission. Reference standard delirium diagnosis (DSM-IV-TR criteria) was obtained within 30 min by a different geriatrician who was blind to the 4AT score. The presence of dementia was assessed using the Alzheimer's Questionnaire and the informant section of the Clinical Dementia Rating scale. The main outcome …