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confusion assessment method (CAM)

Indications: - delirium assessments by non-psychiatrists [2,3,4,5] Procedure: 1) acute change in mental status & fluctuating course* 2) inattention* (see attention assessment) 3) disorganized thinking, or 4) altered level of consciousness (lethargic, stuporous, or comatose) * Diagnosis of delirium requires the presence of these features & either disorganized thinking, or altered level of consciousness * inattention may be tested with digit span, days of the week or months of the year forward & backward (see attention assessment) Notes: - CAM-S provides a delirium severity measure relevant to clinical outcomes [4] - scores range from 0-7 (short form), 0-19 (long form) - adaptation incorporates - sleep disorder - perceptual disorder - 3D-CAM is a 3-minute structured diagnostic assessment for delirium - high sensitivity & specificity for diagnosis of delirium in hospitalized patients - UB-CAM is a version of 3D-CAM that can be completed in ~1 minute - the CAM itself requires substantial interviewer training - apparently a CAM-ICU works as well that does not require verbal responses - 3D-CAM better for diagnosis of delirium [8] - the Family Confusion Assessment Method (FAM-CAM) is concise, easy to use, appropriate for routine clinical practice with sensitivity of 0.74 & specificity of 0.91 [9]

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delirium (acute confusional state)

References

  1. Pisani MA, Redlich C, McNicoll L, Ely EW, Inouye SK. Underrecognition of preexisting cognitive impairment by physicians in older ICU patients. Chest. 2003 Dec;124(6):2267-74. PMID: 14665510
  2. Medical Knowledge Self Assessment Program (MKSAP) 15, 16, 17, 19. American College of Physicians, Philadelphia 2009, 2012, 2015, 2021.
  3. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  4. Inouye SK et al The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts. Ann Intern Med. 2014;160(8):526-533. PMID: 24733193 http://annals.org/article.aspx?articleid=1860529 - EubankKJ and Covinsky KE Delirium Severity in the Hospitalized Patient: Time to Pay Attention. Ann Intern Med. 2014;160(8):574-575 PMID: 24733202 http://annals.org/article.aspx?articleid=1860540
  5. Thomas C, Kreisel SH, Oster P et al Diagnosing delirium in older hospitalized adults with dementia: adapting the confusion assessment method to international classification of diseases, tenth revision, diagnostic criteria. J Am Geriatr Soc. 2012 Aug;60(8):1471-7. PMID: 22881707
  6. Inouye SK, van Dyck CH, Alessi CA et al Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990 Dec 15;113(12):941-8 PMID: 2240918
  7. Marcantonio ER, Ngo LH, O'Connor M et al. 3D-CAM: derivation and validation of a 3--minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161:554-561 PMID: 25329203
  8. Kuczmarska A, Ngo LH, Guess J, O'Connor MA et al Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU. J Gen Intern Med. 2015 Oct 6. [Epub ahead of print] PMID: 26443577
  9. Zhou C, Wang H, Wang L, Zhou Y, Wu Q. Diagnostic accuracy of the Family Confusion Assessment Method for delirium detection: A systematic review and meta-analysis. J Am Geriatr Soc. 2023 Nov 29. PMID: 38018490 Review.