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LSD-4: Letter and Shape Drawing test

2017

A four-drawing visuoconstruction screen evaluated for delirium case-finding in older medical inpatients. It takes about one to two minutes and is a cognitive component test rather than a stand-alone clinical diagnosis.

Classification

Classification

Domain-specific or adjunctive measureCognitive tests designed for delirium

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Tool and original sources

No direct copy is linked here. The original paper and a Google Images search are available below. Image results may be unofficial; check the version and source before use.

Original paper

  • Original paperWilliams OA, O'Connell H, Leonard M, Awan F, White D, McKenna F, et al. Development of the four-item Letter and Shape Drawing test (LSD-4): A brief bedside test of visuospatial function. Psychiatry research. 2017;247:317-322. doi: 10.1016/j.psychres.2016.12.004. PMID: 27951480.

    This is the original published source for LSD-4. It is the main source for the method, its intended use and the evidence available at publication.

One DTA study identifiedCore instrument family

At a glance

Purpose
Domain-specific or adjunctive measure
Population
Adult
Setting
General / acute hospital
Time
approximately 1-2 min
Items
4
Score or threshold
Total 0-4; 3 or less classified abnormal/positive in the 2020 delirium evaluation

Format: A four-drawing visuoconstruction screen completed in about one to two minutes. Each drawing contributes to a four-point total; the study classified scores of 3 or less as abnormal/positive. Use the open primary article for the drawings and exact scoring.

Evidence

Evidence maturityOne DTA study identified

Reported sensitivity and specificity

74%
Sensitivity
75%
Specificity

2020 delirium evaluation in 180 older medical inpatients; the 2017 paper is the canonical test-development source.

More evidence and citation details
Full name
Letter and Shape Drawing test
Also known as
LSD-4
Evidence summary
single
Diagnostic-accuracy studies
1
Reference standard
Full neuropsychiatric reference using DSM-IV and/or DRS-R98 ≥15
Citation
Williams OA, et al. Development of the four-item Letter and Shape Drawing test (LSD-4): A brief bedside test of visuospatial function Psychiatry Research. 2017;247:317-322. PMID 27951480
Copyright and reuse
Information checked
2026-07-19

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Sources checked 2026-07-29. How profiles are prepared.