Delirium is common among hospitalized patients and is associated with poor outcomes. The Confusion Assessment Method (CAM) is a standardized, validated measure that is widely used to screen for the presence of delirium but not its severity. Researchers hypothesized that adding a valid delirium severity measure to the CAM algorithm would be a strong independent predictor of adverse outcomes, such as prolonged hospital stay, functional and cognitive decline, nursing home placement, death, and high health care costs. They developed the CAM-S scoring system and conducted a validation analysis on two independent cohorts – 300 patients aged 70 years and older scheduled for major surgery and 919 medical patients aged 70 and older. Patients with CAM-diagnosed delirium were given a score for features such as inattention, disorganized thinking, and altered level of consciousness. The maximum CAM-S score given during hospitalization was evaluated against hospital and post-hospital outcomes.
The study showed that the CAM-S has good psychometric properties; high inter-rater reliability; and strong association with clinical outcomes related to delirium. The researchers conclude that the CAM-S is a reliable means for rating delirium severity and could be helpful in both research and clinical settings.
Article: The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts, S.K. Inouye, C.M. Kosar, D. Tommet, E.M. Schmitt, M.R. Puelle, J.S. Saczynski, E.R. Marcantonio, and R.N. Jones, Annals of Internal Medicine, DOI: 10.7326/M13-1927, published online 14 April 2014.
American College of Physicians