Confusion Assessment Method

Last updated

Delirium is a common and serious problem, particularly impacting older adults during hospitalization, acute illness, ICU stay, or surgery. Created in 1990 by Dr. Sharon Inouye, the Confusion Assessment Method (CAM) rapidly became among the most widely used tools for identification of delirium, since it provided a quick, accurate, and standardized approach.

Contents

The Confusion Assessment Method (CAM) is a diagnostic tool developed to allow physicians and nurses to identify delirium in the healthcare setting. [1] It was designed to be brief (less than 5 minutes to perform) and based on criteria from the third edition-revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R).[ citation needed ] The CAM rates four diagnostic features, including acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness. The CAM requires that a brief cognitive test is performed before it is completed. It has been translated into more than 20 languages and adapted for use across multiple settings.

Elements of Score

The CAM consists of a short and long form. The CAM short form assesses four features: 1. acute onset or fluctuating course, 2. inattention, 3. disorganized thinking, and 4. altered level of consciousness. The CAM-long form includes the short-form features and adds disorientation, memory impairment, perceptual disturbances, psychomotor agitation or retardation, and altered sleep-wake cycle. These features are based on the 9 features of delirium from DSM-III-R. Each feature is scored as present or absent. Delirium is considered present based on the CAM diagnostic algorithm: presence of (acute onset or fluctuating course -AND‐ inattention) ‐AND EITHER‐ (disorganized thinking or altered level of consciousness) (Table 1). Detailed training and scoring instructions are available here. [2]

Interpretation

In the original study, the 3-5-minute CAM assessment was validated against a >90 minute assessment by reference standard geriatric psychiatrists using DSM-III-R, and found to have a sensitivity and specificity of 94-100% and 90-95%, respectively, for identification of delirium. [1] [3] [4] In a systematic review of 7 high quality studies involving >1000 patients, CAM was found to have a sensitivity of 94%, 95% CI 91-97%; and specificity of 89%, 95% CI 85-94%. [3] A 2013 systematic review of 22 studies involving >2400 patients found a sensitivity of 82%, 95% CI 69-91%; and specificity of 99%, 95% CI 87-100%. [4]

A large high-quality STARD-compliant diagnostic randomized controlled trial published in 2019 comparing the CAM with the 4AT delirium detection tool found that the CAM had lower sensitivity than the 4AT, with the two tools showing similar specificity. [5] Though some studies show good performance of the CAM in research settings, large scale studies of detection of delirium in real-world clinical practice show that the CAM shows a lower sensitivity (as judged by positive score rates in relation to estimated delirium rates) of around 30-40%. [6] [7] [8] [9]

Adaptations

The table below describes delirium assessment tools based on the CAM, their scoring, and available translations. Additional information (for example: administration and instrument validity) may be found here.

CONFUSION ASSESSMENT METHOD ADAPTATIONS
CAM and its AdaptationsDescriptionScoringAvailable Languages

CAM – Short [1]

Confusion Assessment Method – Short

All settings

A 4 question assessment of features including acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness.Delirium scored as ‘present’ (1) or ‘absent’ (0) based on question responses. Positive scores are based on the CAM algorithm, presence of acute onset or fluctuating course and inattention, and either disorganized thinking or altered level of consciousness.English, Arabic, Dutch, French, German, Italian, Polish, Portuguese, Spanish, Thai, Turkish
CAM – Long [1]

Confusion Assessment Method – Long

All settings

A 10 question assessment of features including acute onset and fluctuating course, inattention, disorganized thinking, altered level of consciousness, disturbances, psychomotor agitation and retardation, and altered sleep-walk cycle.Delirium scored as ‘present’ (1) or ‘absent’ (0) based on question responses. Positive scores are based on the CAM algorithm, presence of acute onset or fluctuating course and inattention, and either disorganized thinking or altered level of consciousness.English, Arabic, Dutch, French, German, Italian, Polish, Portuguese, Spanish, Thai, Turkish
CAM-S Short [10]

Confusion Assessment Method – Severity (Short)

All settings

A delirium severity rating scale based on the additive scoring of symptoms rated in the CAM short form (Confusion Assessment Method). The CAM-S is intended to be used in addition to the original CAM algorithm.Rate each symptom of delirium listed in the instrument as absent (0), mild (1), or marked (2), except acute onset or fluctuating course which was rated as absent (0) or present (1). The severity score is created by an additive summary of the ratings ranging from 0–7. Higher scores indicate more severe delirium.English
CAM-S Long [10]

Confusion Assessment Method – Severity (Long)

All settings

A delirium severity rating scale based on the additive scoring of symptoms rated in the CAM long form (Confusion Assessment Method). The CAM-S is intended to be used in addition to the original CAM algorithm.Rate each symptom of delirium listed in the instrument as absent (0), mild (1), or marked (2), except acute onset or fluctuating course which was rated as absent (0) or present (1). The severity score is created by an additive summary of the ratings ranging from 0–19. Higher scores indicate more severe delirium.English
FAM-CAM [11]

Family Confusion Assessment Method

All settings

The FAM‐CAM is an 11-item informant‐based screening instrument to heighten detection of delirium features by family members. It is designed to be used in conjunction with or confirmed by expert clinicians or trained assessors using the Confusion Assessment Method (CAM), and including further assessment and cognitive testing.Each item pertains to a specific feature and is coded as positive or negative. The FAM‐CAM is considered positive according to the CAM diagnostic algorithm:  presence of acute onset or fluctuating course –AND‐ inattention ‐AND EITHER‐ disorganized thinking or altered level of consciousnessEnglish and Spanish
3D-CAM [12]

3-Minute Diagnostic Confusion Assessment Method

All settings

A 3-minute and rating scale that uses verbal responses and observations by the rater to rate the CAM diagnostic algorithm. The clinical version includes skip patterns that can shorten the instrument, while the research version is designed for systematic case-finding for delirium in a research setting and does not include skip patterns. Research and clinical versions exist.Considered positive if 3 out of 4 features are present including acute onset or fluctuating course, inattention, and either disorganize thinking or altered level of consciousness.English, Danish, and Italian (clinical version only)
UB-CAM [13]

Ultra-Brief Confusion Assessment Method

All settings

A two-step protocol with skip pattern involving a clinician-administered two-item interview (UB-2), followed, when positive, by a short interview (3D-CAM) and rating scale that uses verbal responses and observations by the rater to rate the Confusion Assessment Method (CAM) diagnostic algorithm. The following skip pattern is applied—as soon as one incorrect answer or positive patient symptom report or interview observation is positive, the remainder of the items in that CAM feature can be skipped.Begin with 2-item interview. If the patient gets both items correct, the screen is negative for delirium. If one or both items are incorrect, then this is a positive screen, then move to 3D-CAM with skip pattern. Considered positive for delirium based on the CAM diagnostic algorithm: Presence of CAM Features 1 and 2, and either 3 or 4. Each of the 20 items pertains to a specific CAM feature and is coded either yes/no or correct/incorrect.English
CAM-ICU [14] [15]

Confusion Assessment Method for the ICU

ICU

An adaptation of the Confusion Assessment Method (CAM) to be usable by clinicians to screen for delirium in the intensive care unit setting, designed for nonverbal (intubated) patients. The CAM-ICU utilizes the CAM diagnostic algorithm. There are 4 core features including acute onset or fluctuating course, inattention, disorganized thinking, and altered level of consciousness rated with 8 items.3 of the 4 features must be present for CAM-ICU to be considered positive, according to the original CAM algorithm. Items are rated absent/present base on specific thresholds.English, Arabic, Chinese, Czech, Danish, Dutch, Egyptian, French, German, Greek, Hindi, Italian, Japanese, Korean, Malayalam, Marathi, Norwegian, Persian, Polish, Portuguese, Russian, Serbian, Spanish, Swedish, Thai, and Zulu
bCAM [16]

Brief Confusion Assessment Method

Emergency Department

A modification of the Confusion Assessment Method for the Intensive Care Unit (CAM‐ ICU) to quickly screen for delirium outside of the ICU. The bCAM utilizes the CAM diagnostic algorithm. The 4 core features rated with 7 items include acute onset or fluctuating course, inattention, altered level of consciousness, and disorganized thinking.3 of the 4 features must be present for bCAM to be considered positive (1 and 2, and either 3 or 4), according to the original CAM algorithm. Items are rated absent/present. The bCAM scoring sheet is presented as a flow chart to determine delirium presence quickly.  English and Zambian (Bemba and Nyanja dialects available)
CAM-ED [17]

Confusion Assessment Method for the Emergency Department

Emergency Department

The CAM-ED uses a modified CAM algorithm to determine delirium in the Emergency Department. It differs from the CAM only in the presence of a scoring system (from 1 to 4) that allowed more flexibility in assigning the diagnosis of delirium (acute or fluctuating course to be a feature for "probable" delirium). The instrument requires use of the Mini‐Mental State Examination (MMSE). There are 4 core features including acute onset or fluctuating course, inattention, disorganized thinking, and altered level of consciousness rated with 10 items.Delirium scored as ‘delirium’ (scoring 4/4), ‘probable’ (3/4), ‘possible’ (2/4), or ‘No’ (1/4) based on question responses; CAM is considered positive based on the CAM algorithm: presence of acute onset or fluctuating course –AND/OR- inattention -AND EITHER - disorganized thinking or altered level of consciousness.English
mCAM-ED [18] [19]

Modified Confusion Assessment Method for Emergency Department

Emergency Department

The mCAM-ED is based on the original CAM algorithm, modified to screening for inattention using the months of the year in reverse order from the Bedside Confusion Scale by nurses in the emergency department. If inattention is present, then proceed to the MSQ and The Comprehension Test, a subdomain for the Cognitive Test for Delirium. The four features assessed include acute onset or fluctuating course, inattention, disorganized thinking, and altered level of consciousness rated with 15 items.To score inattention: Every omission (from months of the year in reverse order) is scored 1 point, a delay >30 seconds scored 1 additional point. Inattention was present with a score of >2. If inattention present, Mental Status Questionnaire (MSQ) is used to determine altered cognition; if >2 errors are made, then altered cognition is present. Disorganized thinking is tested with The Comprehension Test, present if >2 errors. Altered level of consciousness and fluctuating course are assessed using patient observation during the interview.English and German
NH-CAM [20]

Nursing Home Confusion Assessment Methods

Nursing Home

The four CAM features were modified into the NH-CAM using 9 variables associated with the standard Minimum Data Set (MDS) Resident Assessment Protocol (RAP) (Items B5f, E3, B5a, B5b, B5c, B6, B5d, B5e, E5) for delirium screening of patients within 19 days after admission to the nursing home from hospitalization.CAM is considered positive based on the CAM algorithm: presence of acute onset or fluctuating course –AND- inattention -AND EITHER- disorganized thinking or altered level of consciousnessEnglish

To Learn More

Related Research Articles

Delirium is a specific state of acute confusion attributable to the direct physiological consequence of a medical condition, effects of a psychoactive substance, or multiple causes, which usually develops over the course of hours to days. As a syndrome, delirium presents with disturbances in attention, awareness, and higher-order cognition. People with delirium may experience other neuropsychiatric disturbances, including changes in psychomotor activity, disrupted sleep-wake cycle, emotional disturbances, disturbances of consciousness, or, altered state of consciousness, as well as perceptual disturbances, although these features are not required for diagnosis.

Internal medicine, also known as general internal medicine in Commonwealth nations, is a medical specialty for medical doctors focused on the prevention, diagnosis, and treatment of internal diseases in adults. Medical practitioners of internal medicine are referred to as internists, or physicians in Commonwealth nations. Internists possess specialized skills in managing patients with undifferentiated or multi-system disease processes. They provide care to both hospitalized (inpatient) and ambulatory (outpatient) patients and often contribute significantly to teaching and research. Internists are qualified physicians who have undergone postgraduate training in internal medicine, and should not be confused with "interns”, a term commonly used for a medical doctor who has obtained a medical degree but does not yet have a license to practice medicine unsupervised.

<span class="mw-page-title-main">Pleural effusion</span> Accumulation of excess fluid in the pleural cavity

A pleural effusion is accumulation of excessive fluid in the pleural space, the potential space that surrounds each lung. Under normal conditions, pleural fluid is secreted by the parietal pleural capillaries at a rate of 0.6 millilitre per kilogram weight per hour, and is cleared by lymphatic absorption leaving behind only 5–15 millilitres of fluid, which helps to maintain a functional vacuum between the parietal and visceral pleurae. Excess fluid within the pleural space can impair inspiration by upsetting the functional vacuum and hydrostatically increasing the resistance against lung expansion, resulting in a fully or partially collapsed lung.

<span class="mw-page-title-main">Geriatrics</span> Specialty that focuses on health care of elderly people

Geriatrics, or geriatric medicine, is a medical specialty focused on providing care for the unique health needs of the elderly. The term geriatrics originates from the Greek γέρων geron meaning "old man", and ιατρός iatros meaning "healer". It aims to promote health by preventing, diagnosing and treating disease in older adults. There is no defined age at which patients may be under the care of a geriatrician, or geriatric physician, a physician who specializes in the care of older people. Rather, this decision is guided by individual patient need and the caregiving structures available to them. This care may benefit those who are managing multiple chronic conditions or experiencing significant age-related complications that threaten quality of daily life. Geriatric care may be indicated if caregiving responsibilities become increasingly stressful or medically complex for family and caregivers to manage independently.

<span class="mw-page-title-main">Rectal examination</span> Medical assessment or diagnostic procedure

Digital rectal examination (DRE), also known as a prostate exam, is an internal examination of the rectum performed by a healthcare provider.

Cognitive disorders (CDs), also known as neurocognitive disorders (NCDs), are a category of mental health disorders that primarily affect cognitive abilities including learning, memory, perception, and problem-solving. Neurocognitive disorders include delirium, mild neurocognitive disorders, and major neurocognitive disorder. They are defined by deficits in cognitive ability that are acquired, typically represent decline, and may have an underlying brain pathology. The DSM-5 defines six key domains of cognitive function: executive function, learning and memory, perceptual-motor function, language, complex attention, and social cognition.

The mini–mental state examination (MMSE) or Folstein test is a 30-point questionnaire that is used extensively in clinical and research settings to measure cognitive impairment. It is commonly used in medicine and allied health to screen for dementia. It is also used to estimate the severity and progression of cognitive impairment and to follow the course of cognitive changes in an individual over time; thus making it an effective way to document an individual's response to treatment. The MMSE's purpose has been not, on its own, to provide a diagnosis for any particular nosological entity.

The Abbreviated Mental Test score (AMTS) is a 10-point test for rapidly assessing elderly patients for the possibility of dementia. It was first used in 1972, and is now sometimes also used to assess for mental confusion and other cognitive impairments.

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, commonly called the Beers List, are guidelines published by the American Geriatrics Society (AGS) for healthcare professionals to help improve the safety of prescribing medications for adults 65 years and older in all except palliative settings. They emphasize deprescribing medications that are unnecessary, which helps to reduce the problems of polypharmacy, drug interactions, and adverse drug reactions, thereby improving the risk–benefit ratio of medication regimens in at-risk people.

Excited delirium (ExDS), also known as agitated delirium (AgDS) or hyperactive delirium syndrome with severe agitation, is a controversial and widely rejected diagnosis characterized as a potentially fatal state of extreme agitation and delirium. It has typically been diagnosed postmortem in young adult black males who were physically restrained by law enforcement personnel at the time of death.

<span class="mw-page-title-main">Paratonia</span>

Paratonia is the inability to relax muscles during muscle tone assessment. There are two types of paratonia: oppositional and facilitatory. Oppositional paratonia ("gegenhalten") occurs when subjects involuntarily resist passive movements, while facilitatory paratonia ("mitgehen") occurs when subjects involuntarily assist with passive movements.

Transitional care refers to the coordination and continuity of health care during a movement from one healthcare setting to either another or to home, called care transition, between health care practitioners and settings as their condition and care needs change during the course of a chronic or acute illness. Older adults who suffer from a variety of health conditions often need health care services in different settings to meet their many needs. For young people the focus is on moving successfully from child to adult health services.

<span class="mw-page-title-main">Alvarado score</span>

The Alvarado score is a clinical scoring system used in the diagnosis of appendicitis. Alvarado scoring has largely been superseded as a clinical prediction tool by the Appendicitis Inflammatory Response score.

Sundowning, or sundown syndrome, is a neurological phenomenon associated with increased confusion and restlessness in people with delirium or some form of dementia. It is most commonly associated with Alzheimer's disease but also found in those with other forms of dementia. The term "sundowning" was coined by nurse Lois K. Evans in 1987 due to the timing of the person's increased confusion beginning in the late afternoon and early evening. For people with sundown syndrome, a multitude of behavioral problems begin to occur and are associated with long term adverse outcomes. Sundowning seems to occur more frequently during the middle stages of Alzheimer's disease and mixed dementia and seems to subside with the progression of the person's dementia. People are generally able to understand that this behavioral pattern is abnormal. Research shows that 20–45% of people with Alzheimer's will experience some variation of sundowning confusion. However, despite lack of an official diagnosis of sundown syndrome in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there is currently a wide range of reported prevalence.

<span class="mw-page-title-main">Montreal Cognitive Assessment</span> Screening assessment for detecting cognitive impairment

The Montreal Cognitive Assessment (MoCA) is a widely used screening assessment for detecting cognitive impairment. It was created in 1996 by Ziad Nasreddine in Montreal, Quebec. It was validated in the setting of mild cognitive impairment (MCI), and has subsequently been adopted in numerous other clinical settings. This test consists of 30 points and takes 10 minutes for the individual to complete. The original English version is performed in seven steps, which may change in some countries dependent on education and culture. The basics of this test include short-term memory, executive function, attention, focus, and more.

<span class="mw-page-title-main">Geriatric trauma</span> Medical condition

Geriatric trauma refers to a traumatic injury that occurs to an elderly person. People around the world are living longer than ever. In developed and underdeveloped countries, the pace of population aging is increasing. By 2050, the world's population aged 60 years and older is expected to total 2 billion, up from 900 million in 2015. While this trend presents opportunities for productivity and additional experiences, it also comes with its own set of challenges for health systems. More so than ever, elderly populations are presenting to the Emergency Department following traumatic injury. In addition, given advances in the management of chronic illnesses, more elderly adults are living active lifestyles and are at risk of traumatic injury. In the United States, this population accounts for 14% of all traumatic injuries, of which a majority are just mainly from falls.

Emergence delirium is a condition in which emergence from general anesthesia is accompanied by psychomotor agitation. Some see a relation to pavor nocturnus while others see a relation to the excitement stage of anesthesia.

The 4 'A's Test (4AT) is a bedside medical scale used to help determine if a person has positive signs for delirium. The 4AT also includes cognitive test items, making it suitable also for use as a rapid test for cognitive impairment.

Ziad Nasreddine is a Canadian neurologist notable for creating the Montreal Cognitive Assessment (MoCA).

Sharon Kiyomi Inouye is an American geriatrician. She is the Director of the Aging Brain Center at the Hinda and Arthur Marcus Institute for Aging Research, as well as a professor of medicine at the Harvard Medical School and Beth Israel Deaconess Medical Center. Her career has focused on maintaining healthy brain aging, preventing delirium and functional decline, and optimizing healthcare for older adults. Her recent work has focused on healthy longevity and combating ageism.

References

  1. 1 2 3 4 Inouye, Sharon K. (1990-12-15). "Clarifying Confusion: The Confusion Assessment Method". Annals of Internal Medicine. 113 (12): 941–948. doi:10.7326/0003-4819-113-12-941. ISSN   0003-4819. PMID   2240918.
  2. ↑ "AGS CoCare: HELP". help.agscocare.org. Retrieved 2022-01-06.
  3. 1 2 Wei, Leslie A.; Fearing, Michael A.; Sternberg, Eliezer J.; Inouye, Sharon K. (May 2008). "The Confusion Assessment Method: A Systematic Review of Current Usage: CAM: A SYSTEMATIC REVIEW OF CURRENT USAGE". Journal of the American Geriatrics Society. 56 (5): 823–830. doi:10.1111/j.1532-5415.2008.01674.x. PMC   2585541 . PMID   18384586.
  4. 1 2 Shi, Qiyun; Warren; Saposnik; MacDermid (Sep 2013). "Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy". Neuropsychiatric Disease and Treatment. 9: 1359–1370. doi: 10.2147/NDT.S49520 . ISSN   1176-6328. PMC   3788697 . PMID   24092976.
  5. ↑ Shenkin, Susan D.; Fox, Christopher; Godfrey, Mary; Siddiqi, Najma; Goodacre, Steve; Young, John; Anand, Atul; Gray, Alasdair; Hanley, Janet; MacRaild, Allan; Steven, Jill (2019-07-24). "Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method". BMC Medicine. 17 (1): 138. doi: 10.1186/s12916-019-1367-9 . ISSN   1741-7015. PMC   6651960 . PMID   31337404.
  6. ↑ Friedman, Joseph I.; Li, Lihua; Kirpalani, Sapina; Zhong, Xiaobo; Freeman, Robert; Cheng, Yim Tan; Alfonso, Francis L.; McAlpine, George; Vakil, Aditi; Macon, Bernard; Francaviglia, Paul (January 2021). "A Multi-Phase Quality Improvement Initiative for the Treatment of Active Delirium in Older Persons". Journal of the American Geriatrics Society. 69 (1): 216–224. doi:10.1111/jgs.16897. ISSN   1532-5415. PMID   33150615. S2CID   226259924.
  7. ↑ Reynish, Emma L.; Hapca, Simona M.; De Souza, Nicosha; Cvoro, Vera; Donnan, Peter T.; Guthrie, Bruce (2017-07-27). "Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions". BMC Medicine. 15 (1): 140. doi: 10.1186/s12916-017-0899-0 . ISSN   1741-7015. PMC   5530485 . PMID   28747225.
  8. ↑ Rohatgi, Nidhi; Weng, Yingjie; Bentley, Jason; Lansberg, Maarten G.; Shepard, John; Mazur, Diana; Ahuja, Neera; Hopkins, Joseph (December 2019). "Initiative for Prevention and Early Identification of Delirium in Medical-Surgical Units: Lessons Learned in the Past Five Years". The American Journal of Medicine. 132 (12): 1421–1430.e8. doi:10.1016/j.amjmed.2019.05.035. ISSN   1555-7162. PMID   31228413. S2CID   195298710.
  9. ↑ Corradi, John P.; Chhabra, Jyoti; Mather, Jeffrey F.; Waszynski, Christine M.; Dicks, Robert S. (2016-08-01). "Analysis of multi-dimensional contemporaneous EHR data to refine delirium assessments". Computers in Biology and Medicine. 75: 267–274. doi:10.1016/j.compbiomed.2016.06.013. ISSN   1879-0534. PMID   27340924.
  10. 1 2 Inouye, Sharon K.; Kosar, Cyrus M.; Tommet, Douglas; Schmitt, Eva M.; Puelle, Margaret R.; Saczynski, Jane S.; Marcantonio, Edward R.; Jones, Richard N. (2014-04-15). "The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts". Annals of Internal Medicine. 160 (8): 526–533. doi:10.7326/M13-1927. ISSN   0003-4819. PMC   4038434 . PMID   24733193.
  11. ↑ Steis, Melinda R.; Evans, Lois; Hirschman, Karen B.; Hanlon, Alexandra; Fick, Donna M.; Flanagan, Nina; Inouye, Sharon K. (Nov 2012). "Screening for Delirium via Family Caregivers: Convergent Validity of the Family Confusion Assessment Method (FAM-CAM) and Interviewer-Rated CAM". Journal of the American Geriatrics Society. 60 (11): 2121–2126. doi:10.1111/j.1532-5415.2012.04200.x. ISSN   0002-8614. PMC   3498543 . PMID   23039310.
  12. ↑ Marcantonio, Edward R.; Ngo, Long H.; O'Connor, Margaret; Jones, Richard N.; Crane, Paul K.; Metzger, Eran D.; Inouye, Sharon K. (2014-10-21). "3D-CAM: Derivation and Validation of a 3-Minute Diagnostic Interview for CAM-Defined Delirium: A Cross-sectional Diagnostic Test Study". Annals of Internal Medicine. 161 (8): 554–561. doi:10.7326/M14-0865. ISSN   0003-4819. PMC   4319978 . PMID   25329203.
  13. ↑ Motyl, Claire M.; Ngo, Long; Zhou, Wenxiao; Jung, Yoojin; Leslie, Douglas; Boltz, Marie; Husser, Erica; Inouye, Sharon K.; Fick, Donna; Marcantonio, Edward R. (Nov 2020). "Comparative Accuracy and Efficiency of Four Delirium Screening Protocols". Journal of the American Geriatrics Society. 68 (11): 2572–2578. doi:10.1111/jgs.16711. ISSN   0002-8614. PMC   7814654 . PMID   32930409.
  14. ↑ Marniemi, J.; Parkki, M. G. (1975-09-01). "Radiochemical assay of glutathione S-epoxide transferase and its enhancement by phenobarbital in rat liver in vivo". Biochemical Pharmacology. 24 (17): 1569–1572. doi:10.1016/0006-2952(75)90080-5. ISSN   0006-2952. PMID   9.
  15. ↑ Ely, E. Wesley; Inouye, Sharon K.; Bernard, Gordon R.; Gordon, Sharon; Francis, Joseph; May, Lisa; Truman, Brenda; Speroff, Theodore; Gautam, Shiva; Margolin, Richard; Hart, Robert P. (2001-12-05). "Delirium in Mechanically Ventilated Patients". JAMA. 286 (21): 2703–2710. doi: 10.1001/jama.286.21.2703 . hdl: 10818/12438 . ISSN   0098-7484. PMID   11730446.
  16. ↑ Han, Jin H.; Wilson, Amanda; Vasilevskis, Eduard E.; Shintani, Ayumi; Schnelle, John F.; Dittus, Robert S.; Graves, Amy J.; Storrow, Alan B.; Shuster, John; Ely, E. Wesley (Nov 2013). "Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method". Annals of Emergency Medicine. 62 (5): 457–465. doi:10.1016/j.annemergmed.2013.05.003. PMC   3936572 . PMID   23916018.
  17. ↑ Lewis; et al. (1995). "Unrecognized delirium in ED geriatric patients". The American Journal of Emergency Medicine. 13 (2): 145–2. doi:10.1016/0735-6757(95)90080-2. PMID   7893295.
  18. ↑ Hasemann, Wolfgang; Grossmann, Florian F.; Stadler, Rahel; Bingisser, Roland; Breil, Dieter; Hafner, Martina; Kressig, Reto W.; Nickel, Christian H. (Sep 2018). "Screening and detection of delirium in older ED patients: performance of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). A two-step tool". Internal and Emergency Medicine. 13 (6): 915–922. doi:10.1007/s11739-017-1781-y. ISSN   1828-0447. PMID   29290048. S2CID   36924866.
  19. ↑ Grossmann, Florian F; Hasemann, Wolfgang; Graber, Andreas; Bingisser, Roland; Kressig, Reto W; Nickel, Christian H (2014-03-13). "Screening, detection and management of delirium in the emergency department – a pilot study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED)". Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 22 (1): 19. doi: 10.1186/1757-7241-22-19 . ISSN   1757-7241. PMC   3975151 . PMID   24625212.
  20. ↑ Dosa, David; Intrator, Orna; McNicoll, Lynn; Cang, Yuwei; Teno, Joan (Jul 2007). "Preliminary Derivation of a Nursing Home Confusion Assessment Method Based on Data from the Minimum Data Set". Journal of the American Geriatrics Society. 55 (7): 1099–1105. doi:10.1111/j.1532-5415.2007.01239.x. ISSN   0002-8614. PMID   17608886. S2CID   24261126.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.