Commentary: The pervasive yet elusive problem of delirium after cardiac surgery

Central MessageImproved detection of delirium after cardiac surgery is essential. The 4AT may be an effective screening tool, but further research demonstrating its clinical applicability warranted.See Article page 1151. Improved warranted. See Delirium a common and often under-recognized problem, associated with increased risk probability death hospital readmission, decreased cognitive function, reduced health-related quality life.1Crocker E. Beggs T. Hassan A. Denault Lamarche Y. Bagshaw S. et al.Long-term effects postoperative in patients undergoing operation: systematic review.Ann Thorac Surg. 2016; 102: 1391-1399Abstract Full Text PDF PubMed Scopus (90) Google Scholar It greater who have perioperative complications surgery.2Seese L. Sultan I. Gleason T.G. Navid F. Wang Thoma al.The impact major on long-term survival surgery.Ann 2020; 110: 128-135Abstract (28) Any attempt to improve the prognosis this complication must start early recognition. Several tests, such as Confusion Assessment Method, been developed effort detection.3Hamadnalla H. Sessler D.I. Troianos C.A. Fang J. Rivas Ma C. al.Optimal interval duration CAM-ICU assessments for surgery.J Clin Anesth. 2021; 71: 110233Crossref (10) 4 ‘A’s Test, or 4AT, another established tool that has demonstrated good sensitivity specificity when administered across variety settings internationally.4Tieges Z. Maclullich A.M.J. Anand Brookes Cassarino M. O'connor al.Diagnostic accuracy older adults: review meta-analysis.Age Ageing. 50: 733-743Crossref (62) effectiveness postcardiac setting not yet known. In issue Journal, Chang colleagues5Chang Ragheb Oravec N. Kent D. Nugent K. Cornick “4AT” ward.J Cardiovasc 2023; 165: 1151-1160.e8Abstract (4) seek evaluate detecting among transfer from intensive care unit. study analyzes tool's by assistants nursing staff ward compares it reference standards establish relevance practicality. This topic represents critical gap literature delirium; necessary only acknowledge outcomes validated also prove actually works setting. next steps would link improvement identifying actionable targets. authors conclude sensitive specific test postcardiotomy detection. sensitivity, however, was markedly nurse-administered (58% vs 85% assistant assessments). We wonder whether results differ if instruction administration, frequency timing assessments, comparison were standardized all enabling more data. If remained low addressing these factors, argue against efficacy surgery. A should reproducible user-independent, addition being highly sensitive. unclear, too, why nurse adherence completing assessment so poor. One mentioned barrier administration many seemed still quite sedated. some had unrecognized hypoactive delirium, which can particularly difficult detect. any event, barriers other tests investigated addressed. summary, relevant important common, under-recognized, consequential. With methodology incorporation baseline operative characteristics affect development utility better understood. Diagnostic “4 A's Test” wardThe Journal Thoracic Cardiovascular SurgeryVol. 165Issue 3PreviewDelirium prevalent underdetected ward. aimed validate Test both used subsequently implemented Full-Text