Critical CareCriteria

CAM-ICU Delirium Assessment

Confusion Assessment Method adapted for ICU patients (CAM-ICU). A validated tool for detecting delirium in the ICU, including ventilated patients who cannot speak. Delirium is positive if features 1 AND 2 are present, PLUS either feature 3 OR feature 4.

Parameters

Feature 1: Acute Onset or Fluctuating Course

Acute Mental Status Change from Baseline OR Fluctuating Mental StatusAny evidence of acute change in mental status from patient's baseline, OR mental status that fluctuates during the past 24 hours (RASS score, GCS, or other mental status assessment oscillates).

Feature 2: Inattention (CAM-ICU Attention Test)

Inattention Present: Patient Makes ≥ 3 Errors on ASE Letter Test or Picture TestPerform letter attention test or visual ASE (picture recognition in non-verbal patients). Inattention = ≥ 3 errors out of 10 tests.

Feature 3: Altered Level of Consciousness

Altered Level of Consciousness: RASS ≠ 0 (Not Alert and Calm)RASS score anything other than 0 — this includes RASS +1 to +4 (agitation) OR RASS −1 to −3 (light to moderate sedation). RASS −4 or −5 = UNOBTAINABLE (cannot assess).

Feature 4: Disorganized Thinking

Disorganized Thinking: ≥ 2 Errors on 5-Point Assessment4 yes/no questions + 1 follow command. Score ≥ 2 errors = disorganized thinking.

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