CAM谵妄评分.pdf

Issue Number 13, November 2001 Series Editor: Sheila Molony, MS, RN, C Confusion Assessment Method (CAM) By Christine M. Waszynski RN, C, MS, APRN WHY: Approximately 15 - 60 % of elderly patients experience a delirium prior to or during a hospitalization but the diagnosis is missed in up to 70% of cases. Delirium is associated with poor outcomes such as prolonged hospitalization, functional decline, and increased use of chemical and physical restraints. Delirium increases the risk of nursing home admission. Individuals at high risk for delirium should be assessed daily using a standardized tool to facilitate prompt identification and management. Risk factors for delirium include older age, prior cognitive impairment, presence of infection, severe illness or multiple co-morbidities, dehydration, psychotropic medication use, alcoholism, vision impairment and fractures. BEST TOOL: The Confusion Assessment Method (CAM) includes two parts. Part one is an assessment instrument that screens for overall cognitive impairment. Part two includes only those four features that were found to have the greatest ability to distinguish delirium or reversible confusion from other types of cognitive impairment. VALIDITY/RELIABILITY: Concurrent validation with psychiatric diagnosis revealed sensitivity of 94- 100% and specificity of 90-95%. The CAM significantly correlated with the Mini-Mental Status Examination, the Visual Analog Scale for Confusion and the digit span test. STRENGTHS AND LIMITATIONS: The tool can be administered in less than 5 minutes. It closely correlates with DSM-IV criteria for delirium. There is a false positive rate of 10% and the instrument has not been widely tested as a bedside tool for nurse raters. The tool identifies the presence or absence of delirium but does not assess the severity of the condition, making it less useful to de