Delirium

Confusion Assessment Method (CAM):

1. Acute onset and fluctuating course

   1. Is there an acute change in mental status from the patient’s baseline? Did this behavior fluctuate during the past day (tend to come and go or increase and decrease in severity)?

2. Inattention

• 1. Does the patient have difficulty focusing attention, for example, being easily distractible, or having difficulty keeping track of what was being said?

3. Disorganized thinking

• 1. Is the patient’s speech disorganized or incoherent, such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?

4. Altered level of consciousness

• 1. Overall, how would you rate this patient’s level of consciousness? Alert (normal), Vigilant (hyperalert), Lethargic (drowsy, easily aroused), Stupor (difficult to arouse), Coma (unarousable)

The diagnosis of delirium requires a present/abnormal rating for features 1 and 2, AND also for EITHER feature 3 or 4.

High sensitivity (94-100%), specificity (90- 95%), PPV and NPV. Demonstrates convergence validity and  high inter-observer reliability (kappa = 0.81 - 1.0)