Delirium Assessment

The 2002 clinical practice guidelines of the Society of Critical Care Medicine (SCCM) for the sustained use of analgesics and sedatives are geared toward the maintenance of optimal comfort in critically ill patients by focusing on 3 central components - pain, anxiety and delirium. The third component of these guidelines, delirium, is an independent predictor of death, length of stay, cost, and cognitive outcomes at discharge. Although, it is experienced by 60-80% of mechanically ventilated patients, it remains unrecognized in 66% to 84% of patients. The SCCM guidelines recommended that the emergence and/or persistence of delirium be regularly monitored in critically ill patients.

The Confusion Assessment Method for the ICU (CAM-ICU) is a delirium monitoring instrument for ICU patients. The CAM-ICU was adapted for use in nonverbal ICU patients from the original Confusion Assessment Method (CAM) (Inouye, Ann Intern Med 1990). The CAM-ICU is a well validated delirium assessment scale that is widely used and easy to administer. It was shown to be reliable and valid in 2 investigations using geriatric-psychiatric DSM-IV ratings in over 750 patient observations (Ely, JAMA 2001 and Ely, Crit Car Med 2001). It performs well even among difficult patient populations (i.e. patients with suspected dementia, patients over 65 years old, and those with very high severity of illness). The CAM-ICU was designed to be a serial assessment tool for use by bedside clinicians (e.g. nurses, physicians, etc). Thus it is easy to use, taking less than 2 minutes to complete and requiring minimal training.

The Intensive Care Delirium Screening Checklist (ICDSC) is an eight item checklist based on DSM-IV Criteria and features of delirium. It is intended to be a bedside screening tool for delirium in the intensive care unit. Raters complete the checklist based on data from the previous 24 hours. The eight items are scored 1 (present) or 0 (absent), for a total of 8 points. A score of 4 or greater is a positive screen for delirium.
Reference: Bergeron N, Dubois MJ, Dumont M, Dial S, Skrobik Y Intensive Care Med. 2001 May;27(5):859-64.

CAM-ICU Training Manual Page (This pages contains links to the CAM-ICU Training Manual, Instructional Videos, Frequently Asked Questions, Worksheets, and Translations)

Implementation (This page contains helpful hints on successful bedside implementation of the CAM-ICU)