CAM (5 minutes)
The CAM has been extensively validated in older adults using raters with different clinical backgrounds
Wong et al performed a meta-analysis that included 12 studies that enrolled 1,036 patients. Based upon the likelihood ratios, a positive CAM strongly increases the odds of delirium, and a negative CAM moderately to strongly decreases the likelihood of delirium. There is limited validation for older ED patients; Fabbri et al observed that the CAM was 94% and 96% specific when performed by geriatricians.
1Wong CL, et al. JAMA. 2010;304(7):779–786. 2Fabbri RM, et al. Arq Neuropsiquiatr. 2001;59(2-a):175–179.
CAM, Confusion Assessment Method
ED, emergency department
LR, likelihood ratio
Advantages and disadvantages of the 5-minute CAM
ADVANTAGES
- Widely validated across multiple clinical settings
- Higher ceiling for sensitivity and specificity
DISADVANTAGES
- Requires cognitive assessment
- Subjective impression
- Requires extensive training
- Clinically inexperienced raters have poorer diagnostic performance
- Can take 5 minutes
- Limited ED validation
NOTE
Because the CAM relies on the rater’s clinical judgment to determine Features 2 (inattention) and 3 (disorganized thinking), it is operator dependent.
The CAM’s diagnostic accuracy may be poorer in nonphysicians and those with limited training. Therefore, the CAM requires extensive training to perform accurately and reliably.
However, of all the delirium assessments reviewed, the CAM has the highest ceiling with regard to diagnostic accuracy, especially if performed by an experienced rater.
Resources
Additional details about the CAM, including the instruction manual, can be seen at www.hospitalelderlifeprogram.org.
Abbreviations
CAM, Confusion Assessment Method
ED, emergency department