Don't Just Recognize Delirium, Measure It
Neil H. Winawer, MD, FHM
A new delirium severity measure, the CAM-S, is associated strongly with important clinical outcomes.
The Confusion Assessment Method (CAM) has gained widespread acceptance for diagnosing delirium, because it is validated and easy to use at the bedside. However, we don't have a simple clinical tool to assess severity of delirium once it occurs.
Researchers have developed two new CAM-based scoring systems for delirium severity (CAM-S): a long form (based on the 10 features of the full CAM instrument) and a short form (based on the 4 features from CAM that can be rated at the bedside). The short-form items are:
Each symptom (except fluctuation) was rated 0 (absent), 1 (mild), or 2 (marked); acute onset and fluctuation was rated 0 (absent) or 1 (present).
The CAM-S was validated in two older U.S. cohorts (age, ≥70): 300 surgery patients and 900 medical patients. Both versions of the CAM-S demonstrated a powerful graded association with outcomes: As delirium severity score increased, risk for death, nursing home placement, functional decline, and extended hospital stays also increased.
Citation(s):
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 Apr 15; 160:526.
