First posted by Charles Gomersall November 2009
Patient classified as having delirium if has features 1 AND 2 AND either 3 OR
Feature 1. Acute Onset of
Mental Status Changes or Fluctuating Course
Is there evidence
of an acute change in mental status from the baseline?
Or has the
(abnormal) behavior fluctuated during the past 24 hrs, that is, tended to
come and go or increase and decrease in severity as evidenced by fluctuation
in Glasgow Coma score or sedation score or by direct observation of patient?
Feature 2. Inattention
Does the patient have
difficulty focusing attention as evidenced by score of <8 correct answers on
picture recognition or vigilance A random letter test (neither of these tests
require verbal response)?
Was the patient’s
thinking disorganized or incoherent, such as rambling or irrelevant
conversation, unclear or illogical flow of ideas, or unpredictable switching
from subject to subject?
If the patient is
unable to speak ask the following questions and ask the patient to respond
to the following "commands":
Will a stone float on water?
Are there fish in the sea?
Can 1 pound weigh more than 2 pounds?
Can you use a hammer to pound a nail?
having any unclear thinking?
this many fingers (examiner holds two fingers in front of the
the same thing with the other hand (without holding up two fingers
in front of the patient)
Feature 4. Altered Level of Consciousness
Any level of
consciousness other than “alert.”
spontaneously fully aware of environment and interacts appropriately
but easily aroused, unaware of some elements in the environment, or not
spontaneously interacting appropriately with the interviewer; becomes fully
aware and appropriately interactive when prodded minimally
to arouse, unaware of some or all elements in the environment, or not
spontaneously interacting with the interviewer; becomes incompletely aware
and inappropriately interactive when prodded strongly
unaware of all elements in the environment, with no spontaneous interaction
or awareness of the interviewer, so that the interview is difficult or
impossible even with maximal prodding
Ely EW et al.
Evaluation of delirium in critically ill patients: validation of the Confusion
Assessment Method for the Intensive Care Unit (CAM-ICU). Crit Care Med,2001;