Delirium – Diagnosing Delirium

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Delirium – Diagnosing Delirium

geriguidesOctober 13, 2021List of Guides 0

Delirium is diagnosted using either of the two diagnostic criteria(DSM-5 and CAM):

DSM-5 Criteria

DSM-5 requires that all six criteria be met:

  1. Disturbance in attention and awareness
  2. Disturbance develops acutely and tends to fluctuate in severity
  3. At least one additional disturbance in cognition
  4. Disturbances are note better explained by a preexisting dementia
  5. Disturbances do not occur in context of a severely reduced level of arousal, such as a coma
  6. Evidence of an underlying organic cause or causes
CAM Criteria

The Confusion Assessment Method (CAM) requires:

  1. Acute onset OR fluctuating course

    AND
  2. Inattention

    PLUS
  3. Disorganized thinking

    OR
  4. Altered level of consciousness

Both DSM-5 and CAM criteria can be subjective especially if you are new to evaluating delirium. We recommend using validated, standardized tools:

  • For floor patients, use the 3D-CAM (link to practice manual, see last page for assessment)
    • The UB-CAM App (available in the Apple Store) is an easy, efficient and adaptative combination of the UB-2 (screening) and 3D-CAM (diagnostic). It has a sensitivity and specificity of 93% and 95%, respectively, and takes about 74 seconds to administer (median of 40 seconds). Visit the NIDUS Delirium Network for more information.
  • For ICU patients, use the CAM-ICU (link to MDCalc)

You may find many more CAM assessments at https://help.agscocare.org/productAbstract/H00101. Registration is free.