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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.

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.

Primary validation papers

1 identified diagnostic-accuracy paper

Other forms of validation are described in the evidence section. What is counted?

Large-scale clinical implementation

Not yet reviewed.

A focused implementation review has not yet been completed for this profile.

Training and instructions

Public training resources have not yet been confirmed in this review. Check the linked developer or original source for instructions.

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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.

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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.

    Open PubMed ↗
One DTA study identifiedCore instrument family
Classification

Classification

Domain-specific or adjunctive measureCognitive tests designed for delirium

A tool may belong to more than one category. Select a linked category to see other relevant profiles.

Evidence

Diagnostic-accuracy evidenceOne 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 evaluations
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
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Primary validation studies

Distinct primary publications from the current diagnostic-accuracy audit. Reviews and repeated evaluations within one paper are not counted again. Overlapping cohorts have not all been reconciled. Read the counting rules and limitations.

Open 1 identified paper
  1. Meagher DJ, O'Connell H, Leonard M, Williams O, Awan F, Exton C, Tenorio M, O'Connor M, Dunne CP, Cullen W, McFarland J, Adamis D (2020). Comparison of novel tools with traditional cognitive tests in detecting delirium in elderly medical patients. World journal of psychiatry.

    Reference category: other comparator or secondary accuracy evidence.

Copyright and reuse
Information checked
2026-07-19

Instrument-specific terms apply. See the access and copyright policy or send a correction.

Base clinical review: 2026-07-29. Instrument description source check: 2026-09-05. Scope and limitations.