Assessment Tool: CAM

The Confusion Assessment Method identifies delirium using a four-feature diagnostic algorithm. A positive screen requires urgent clinical evaluation and cause-directed management.

Confusion Assessment Method (CAM)

A validated algorithm to identify delirium at the bedside. Delirium is present when Features 1 and 2 are both positive AND at least one of Features 3 or 4 is positive.

CAM diagnostic algorithm: Feature 1 AND Feature 2 AND (Feature 3 OR Feature 4) = Delirium

Feature 1: Acute Onset and Fluctuating Course (required)

Is there evidence of an acute change in mental status from the patient's baseline? Does the behaviour tend to fluctuate throughout the day?

Yes No

Feature 2: Inattention (required)

Does the patient have difficulty focusing attention? For example, is the patient easily distracted, or does the patient have difficulty keeping track of what is being said?

Yes No

Feature 3: Disorganised Thinking (Feature 3 OR 4 required)

Is the patient's thinking disorganised or incoherent? For example, rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject.

Yes No

Feature 4: Altered Level of Consciousness (Feature 3 OR 4 required)

How would you rate the patient's level of consciousness overall? Anything other than Alert is considered a positive finding.

Alert

Normal

Vigilant

Hyperalert

Lethargic

Drowsy, easily aroused

Stupor

Difficult to arouse

Coma

Unarousable

Assessment Result

A CAM-positive screen is a clinical priority. Identify and treat the underlying cause: infection, metabolic disturbance, medication effect, pain, urinary retention, constipation, hypoxia, or dehydration.

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