Delirium Screening: CAM-ICU

The Confusion Assessment Method-ICU (CAM-ICU) is extensively validated and used for delirium diagnosis and evaluation of delirium over time. It allows the assessment of attention, orientation, and memory. Of note, this tool allows nonpsychiatric ICU personnel to diagnose the complication rapidly and reliably and can be adopted even when the patient is unable to speak due to endotracheal intubation.
The CAM-ICU provides two steps. In the first one, the level of consciousness/arousal is evaluated through a standardized sedation scale such as the Richmond Agitation-Sedation Scale (RASS). This latter is a 10-point scale ranging from +4 to -5, where a RASS value of 0 indicates a calm and alert patient; RASS scores of -4 and -5 are indicative of coma and cannot be further assessed for delirium.
All other individuals (moderately sedated, RASS score -3 or more alert) should also be evaluated through the second step assesses patients for four characteristics of delirium. The categories include acute onset of altered mental status, inattention, disorganized thinking, or altered level of consciousness. Three out of four features are required for a diagnosis of delirium. The tools, validated in 1990, has been updated by Marcantonio et al. in 2014, in the 3-Minute Diagnostic Assessment for Delirium (3D-CAM). It is an algorithm easy to perform and can be used by personnel with minimal additional training.