Don't Just Recognize Delirium, Measure It

May 22, 2014

Don't Just Recognize Delirium, Measure It

  1. Neil H. Winawer, MD, SFHM

A new delirium severity measure, the CAM-S, is associated strongly with important clinical outcomes.

  1. Neil H. Winawer, MD, SFHM

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:

  • Acute onset and symptom fluctuation

  • Inattention

  • Disorganized thinking

  • Altered level of consciousness

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.

Comment

The CAM-S goes beyond simply asking if delirium is present and asks, “How bad is it?” We really don't know whether prompt recognition of delirium (and treatment of the underlying cause) can prevent associated complications. However, the CAM-S provides a quantifiable method of evaluating the severity of delirium and correlating severity with outcomes.

Editor Disclosures at Time of Publication

  • Disclosures for Neil H. Winawer, MD, SFHM at time of publication Consultant / Advisory board Marathon Pharmaceuticals Editorial boards ACP Hospitalist (Board Member)

Citation(s):

Reader Comments (2)

KRISHNAKUMAR SUKUMARAN Physician, Nephrology, SUT Royal ,Trivandrum,India

Stresses the importance of clinical medicine in patient care and propagating importance of advances in individualized medicare

KRISHNAKUMAR SUKUMARAN Physician, Nephrology, SUT ROYAL HOSPITAL

Helps to identify and evaluate this important cliical clue

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