Confusion Assessment Method for the ICU (CAM-ICU)
Establishes ability to detect delirium in high risk settings.
When to Use
The CAM-ICU should be used daily on all patients admitted to the ICU even if they are mechanically ventilated.
- Delirium has been shown to be associated with worse outcomes in critically ill patients. It remains underdiagnosed given its sometimes subtle presentation.
- The CAM-ICU score is a validated and commonly used score to help monitor patients for the development or resolution of delirium.
- It is an adaptation of the Confusion Assessment Method (CAM) score for use in ICU patients.
- Since the first step of the score consists of identifying an “acute change from mental status baseline”, it may be difficult to use in patients in whom the neurologic baseline is unknown.
- If a patient’s neurologic baseline changes during the course of his hospitalization (such as a new CVA for example), then the new baseline should be used for any new assessment.
- In order for the CAM-ICU score to be accurate, patients should not be sedated, or have a RASS of 0.
- Delirium affects up to 89% of ICU patients and has been shown to result in higher mortality. The relative risk of death increases for each day the patient remains delirious. Prompt recognition of this condition is therefore important.
- To this day delirium remains a clinical diagnosis. Few clinical tools have been demonstrated to be useful in helping identify the presence or absence of delirium.