A new easy-to-use scoring system for severity of delirium has been developed and validated (Inouye 2014). The tool, CAM-S, is based on the Confusion Assessment Method (CAM) which is already widely used as a screening tool for delirium. There are actually 2 forms, one a 4-item tool and the other a 10-item tool. Both were validated in 2 independent populations and have good inter-rater reliability. Increasing severity on these two scores is associated with worse outcomes (length of stay, hospital costs, nursing home placement, cognitive decline, death within 90 days, and functional decline at 30 days). Previous systems for scoring severity of delirium have not been widely adopted. The new system will likely be better utilized because of its relationship to the CAM and it doesnt require special training to administer. The short form takes only 5 minutes to complete. The tool(s) may help follow the clinical progress of patients with delirium, determine whether the patient is improving and responding to management interventions, and be of prognostic value. They likely will also play a key role in future research and clinical trials.
The accompanying editorial (Eubank 2014) notes that delirium has a risk of death similar to that for myocardial infarction and severity of complications and costs similar to diabetes yet has never received the amount of attention that either of those 2 conditions have.
This is a welcome scoring system and we expect youll hear a lot more about its use in the next few years.
Some of our prior columns on delirium assessment and management:
· October 21, 2008 Preventing Delirium
· October 14, 2009 Managing Delirium
· February 10, 2009 Sedation in the ICU: The Dexmedetomidine Study
· March 31, 2009 Screening Patients for Risk of Delirium
· June 23, 2009 More on Delirium in the ICU
· January 26, 2010 Preventing Postoperative Delirium
· August 31, 2010
· September 2011 Modified HELP Helps Outcomes in Elderly Undergoing Abdominal Surgery)
· December 2010 The ABCDE Bundle
· February 28, 2012 AACN Practice Alert on Delirium in Critical Care
· April 3, 2012 New Risk for Postoperative Delirium: Obstructive Sleep Apnea
· August 7, 2012 Cognition, Post-Op Delirium, and Post-Op Outcomes
· September 2013 Disappointing Results in Delirium
· October 29, 2013 PAD: The Pain, Agitation, and Delirium Care Bundle
· February 2014 New Studies on Delirium
· March 25, 2014 Melatonin and Delirium
Inouye SK, Kosar CM, Tommet D, et al. The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts. Ann Intern Med 2014; 160(8):526-533
Eubank KJ, Covinsky KE. Delirium Severity in the Hospitalized Patient: Time to Pay Attention. Ann Intern Med 2014; 160(8): 574-575
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