bCAM

Aka: bCAM, Brief Confusion Assessment Method

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II. Indications

  1. Delirium Evaluation

III. Technique

  1. Step 1: Altered Mental Status change from baceline or fluctuating course over prior 24 hours
    1. Positive
      1. Go to Step 2
    2. Negative
      1. Stop - Negative for Delirium
  2. Step 2: Inattention present
    1. Technique
      1. Examiner: "Can you name the months backwards from December to July?"
    2. Positive (More than 1 error)
      1. Go to step 3
    3. Negative
      1. Stop - Negative for Delirium
  3. Step 3: Altered Level of Consciousness present
    1. Assess alertness
      1. Alert (normal)
      2. Hyperalert or vigilant
      3. Lethargic or drowsy (easily aroused)
      4. Stuporous (difficult to arouse)
      5. Comatose (unarousable)
    2. Positive (not alert)
      1. Stop - POSITIVE for Delirium
    3. Negative (alert)
      1. Go to Step 4
  4. Step 4: Disorganized Thinking
    1. Questions
      1. "Will a stone float on water?"
      2. "Are there fish in the sea?"
      3. "Does one pound weigh more than two pounds?"
      4. "Can you use a hammer to pound a nail?"
    2. Command
      1. Examiner: "Hold up this many fingers"
        1. Examiner holds up 2 fingers
        2. Patient should hold up 2 fingers with one hand
      2. Examiner: "Now do the same thing with the other hand"
        1. Examiner does not demonstrate this time
        2. Patient should hold up 2 finger on the opposite hand
        3. Alternatively (if patient unable to move both hands): "Now hold up 3 fingers"
    3. Positive (2 or more errors)
      1. POSITIVE for Delirium
    4. Negative (0 or 1 error)
      1. Negative for Delirium

IV. Efficacy: Delirium Diagnosis

  1. Test Sensitivity: 84% (78% if non-physician performs)
  2. Test Specificity: 96%

V. Resources

  1. Vanderbilt ICU Delirium
    1. http://icudelirium.org/delirium/monitoring.html

VI. References

  1. Ely (2001) Crit Care Med 29:1370-9 -Inouye (1990) Ann Intern Med 113: 941-8 [PubMed]

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