The 4AT Assessment
Four items, about two minutes – based on observation, direct testing, and information from staff, records or family.
1. Alertness
Observe the patient. If asleep, attempt to wake with speech or a gentle touch on the shoulder. Includes patients who may be markedly drowsy (e.g. difficult to rouse and/or obviously sleepy during assessment) or agitated/hyperactive.
digital or
print?
Access the 4AT tool in the format that best suits your clinical workflow and environment.
Web Tool
Use the interactive assessment above for instant scoring.
Official 4AT form and translations – the4at.com
Download the official PDF version to print and keep in your clinical folder or ward.
Research
The evidence
The 4AT is validated in 33 published diagnostic accuracy studies. In a meta-analysis of 17 studies, pooled sensitivity was 88% and specificity 88% (Tieges et al., Age and Ageing 2021). NICE's updated delirium guideline (2023) recommends the 4AT for delirium assessment when indicators of delirium are identified.