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Confusion Assessment Method

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perceptual disturbances, psychomotor agitation or retardation, and altered sleep-wake cycle. These features are based on the 9 features of delirium from DSM-III-R. Each feature is scored as present or absent. Delirium is considered present based on the CAM diagnostic algorithm: presence of (acute onset or fluctuating course -AND‐ inattention) ‐AND EITHER‐ (disorganized thinking or altered level of consciousness) (Table 1). Detailed training and scoring instructions are available here.
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review of 7 high quality studies involving >1000 patients, CAM was found to have a sensitivity of 94%, 95% CI 91-97%; and specificity of 89%, 95% CI 85-94%. A 2013 systematic review of 22 studies involving >2400 patients found a sensitivity of 82%, 95% CI 69-91%; and specificity of 99%, 95% CI 87-100%.
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The four CAM features were modified into the NH-CAM using 9 variables associated with the standard Minimum Data Set (MDS) Resident Assessment Protocol (RAP) (Items B5f, E3, B5a, B5b, B5c, B6, B5d, B5e, E5) for delirium screening of patients within 19 days after admission to the nursing home from
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A modification of the Confusion Assessment Method for the Intensive Care Unit (CAM‐ ICU) to quickly screen for delirium outside of the ICU. The bCAM utilizes the CAM diagnostic algorithm. The 4 core features rated with 7 items include acute onset or fluctuating course, inattention, altered level
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Each item pertains to a specific feature and is coded as positive or negative. The FAM‐CAM is considered positive according to the CAM diagnostic algorithm:  presence of acute onset or fluctuating course –AND‐ inattention ‐AND EITHER‐ disorganized thinking or altered level of consciousness
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To score inattention: Every omission (from months of the year in reverse order) is scored 1 point, a delay >30 seconds scored 1 additional point. Inattention was present with a score of >2. If inattention present, Mental Status Questionnaire (MSQ) is used to determine altered cognition; if
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Begin with 2-item interview. If the patient gets both items correct, the screen is negative for delirium. If one or both items are incorrect, then this is a positive screen, then move to 3D-CAM with skip pattern. Considered positive for delirium based on the CAM diagnostic algorithm: Presence of
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A two-step protocol with skip pattern involving a clinician-administered two-item interview (UB-2), followed, when positive, by a short interview (3D-CAM) and rating scale that uses verbal responses and observations by the rater to rate the Confusion Assessment Method (CAM) diagnostic algorithm.
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Rate each symptom of delirium listed in the instrument as absent (0), mild (1), or marked (2), except acute onset or fluctuating course which was rated as absent (0) or present (1). The severity score is created by an additive summary of the ratings ranging from 0–19. Higher scores indicate more
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Rate each symptom of delirium listed in the instrument as absent (0), mild (1), or marked (2), except acute onset or fluctuating course which was rated as absent (0) or present (1). The severity score is created by an additive summary of the ratings ranging from 0–7. Higher scores indicate more
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The CAM consists of a short and long form. The CAM short form assesses four features: 1. acute onset or fluctuating course, 2. inattention, 3. disorganized thinking, and 4. altered level of consciousness. The CAM-long form includes the short-form features and adds disorientation, memory impairment,
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A 3-minute and rating scale that uses verbal responses and observations by the rater to rate the CAM diagnostic algorithm. The clinical version includes skip patterns that can shorten the instrument, while the research version is designed for systematic case-finding for delirium in a research
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The FAM‐CAM is an 11-item informant‐based screening instrument to heighten detection of delirium features by family members. It is designed to be used in conjunction with or confirmed by expert clinicians or trained assessors using the Confusion Assessment Method (CAM), and including further
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In the original study, the 3-5-minute CAM assessment was validated against a >90 minute assessment by reference standard geriatric psychiatrists using DSM-III-R, and found to have a sensitivity and specificity of 94-100% and 90-95%, respectively, for identification of delirium. In a systematic
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Delirium scored as ‘delirium’ (scoring 4/4), ‘probable’ (3/4), ‘possible’ (2/4), or ‘No’ (1/4) based on question responses; CAM is considered positive based on the CAM algorithm: presence of acute onset or fluctuating course –AND/OR- inattention -AND EITHER - disorganized thinking or altered
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delirium detection tool found that the CAM had lower sensitivity than the 4AT, with the two tools showing similar specificity. Though some studies show good performance of the CAM in research settings, large scale studies of detection of delirium in real-world clinical practice show that the CAM
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The CAM-ED uses a modified CAM algorithm to determine delirium in the Emergency Department. It differs from the CAM only in the presence of a scoring system (from 1 to 4) that allowed more flexibility in assigning the diagnosis of delirium (acute or fluctuating course to be a feature for
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The mCAM-ED is based on the original CAM algorithm, modified to screening for inattention using the months of the year in reverse order from the Bedside Confusion Scale by nurses in the emergency department. If inattention is present, then proceed to the MSQ and The Comprehension Test, a
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An adaptation of the Confusion Assessment Method (CAM) to be usable by clinicians to screen for delirium in the intensive care unit setting, designed for nonverbal (intubated) patients. The CAM-ICU utilizes the CAM diagnostic algorithm. There are 4 core features including acute onset or
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3 of the 4 features must be present for bCAM to be considered positive (1 and 2, and either 3 or 4), according to the original CAM algorithm. Items are rated absent/present. The bCAM scoring sheet is presented as a flow chart to determine delirium presence quickly.  
337:>2 errors are made, then altered cognition is present. Disorganized thinking is tested with The Comprehension Test, present if >2 errors. Altered level of consciousness and fluctuating course are assessed using patient observation during the interview. 312:"probable" delirium). The instrument requires use of the Mini‐Mental State Examination (MMSE). There are 4 core features including acute onset or fluctuating course, inattention, disorganized thinking, and altered level of consciousness rated with 10 items. 148:
Delirium scored as ‘present’ (1) or ‘absent’ (0) based on question responses. Positive scores are based on the CAM algorithm, presence of acute onset or fluctuating course and inattention, and either disorganized thinking or altered level of consciousness.
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Delirium scored as ‘present’ (1) or ‘absent’ (0) based on question responses. Positive scores are based on the CAM algorithm, presence of acute onset or fluctuating course and inattention, and either disorganized thinking or altered level of consciousness.
1326:"Screening, detection and management of delirium in the emergency department – a pilot study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED)" 144:
A 10 question assessment of features including acute onset and fluctuating course, inattention, disorganized thinking, altered level of consciousness, disturbances, psychomotor agitation and retardation, and altered sleep-walk cycle.
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English, Arabic, Chinese, Czech, Danish, Dutch, Egyptian, French, German, Greek, Hindi, Italian, Japanese, Korean, Malayalam, Marathi, Norwegian, Persian, Polish, Portuguese, Russian, Serbian, Spanish, Swedish, Thai, and Zulu
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A delirium severity rating scale based on the additive scoring of symptoms rated in the CAM short form (Confusion Assessment Method). The CAM-S is intended to be used in addition to the original CAM algorithm.
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subdomain for the Cognitive Test for Delirium. The four features assessed include acute onset or fluctuating course, inattention, disorganized thinking, and altered level of consciousness rated with 15 items.
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A delirium severity rating scale based on the additive scoring of symptoms rated in the CAM long form (Confusion Assessment Method). The CAM-S is intended to be used in addition to the original CAM algorithm.
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The following skip pattern is applied—as soon as one incorrect answer or positive patient symptom report or interview observation is positive, the remainder of the items in that CAM feature can be skipped.
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Friedman, Joseph I.; Li, Lihua; Kirpalani, Sapina; Zhong, Xiaobo; Freeman, Robert; Cheng, Yim Tan; Alfonso, Francis L.; McAlpine, George; Vakil, Aditi; Macon, Bernard; Francaviglia, Paul (January 2021).
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The table below describes delirium assessment tools based on the CAM, their scoring, and available translations. Additional information (for example: administration and instrument validity) may be found
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Ely, E. Wesley; Inouye, Sharon K.; Bernard, Gordon R.; Gordon, Sharon; Francis, Joseph; May, Lisa; Truman, Brenda; Speroff, Theodore; Gautam, Shiva; Margolin, Richard; Hart, Robert P. (2001-12-05).
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CAM is considered positive based on the CAM algorithm: presence of acute onset or fluctuating course –AND- inattention -AND EITHER- disorganized thinking or altered level of consciousness
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Shenkin, Susan D.; Fox, Christopher; Godfrey, Mary; Siddiqi, Najma; Goodacre, Steve; Young, John; Anand, Atul; Gray, Alasdair; Hanley, Janet; MacRaild, Allan; Steven, Jill (2019-07-24).
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Han, Jin H.; Wilson, Amanda; Vasilevskis, Eduard E.; Shintani, Ayumi; Schnelle, John F.; Dittus, Robert S.; Graves, Amy J.; Storrow, Alan B.; Shuster, John; Ely, E. Wesley (Nov 2013).
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Considered positive if 3 out of 4 features are present including acute onset or fluctuating course, inattention, and either disorganize thinking or altered level of consciousness.
40:. The CAM requires that a brief cognitive test is performed before it is completed. It has been translated into more than 20 languages and adapted for use across multiple settings. 273:
3 of the 4 features must be present for CAM-ICU to be considered positive, according to the original CAM algorithm. Items are rated absent/present base on specific thresholds.
33: 1271:"Screening and detection of delirium in older ED patients: performance of the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). A two-step tool" 1022:
Motyl, Claire M.; Ngo, Long; Zhou, Wenxiao; Jung, Yoojin; Leslie, Douglas; Boltz, Marie; Husser, Erica; Inouye, Sharon K.; Fick, Donna; Marcantonio, Edward R. (Nov 2020).
574:"Delirium detection in older acute medical inpatients: a multicentre prospective comparative diagnostic test accuracy study of the 4AT and the confusion assessment method" 689:"Epidemiology and outcomes of people with dementia, delirium, and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions" 851:
Inouye, Sharon K.; Kosar, Cyrus M.; Tommet, Douglas; Schmitt, Eva M.; Puelle, Margaret R.; Saczynski, Jane S.; Marcantonio, Edward R.; Jones, Richard N. (2014-04-15).
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Hasemann, Wolfgang; Grossmann, Florian F.; Stadler, Rahel; Bingisser, Roland; Breil, Dieter; Hafner, Martina; Kressig, Reto W.; Nickel, Christian H. (Sep 2018).
1187:"Diagnosing Delirium in Older Emergency Department Patients: Validity and Reliability of the Delirium Triage Screen and the Brief Confusion Assessment Method" 124:
A 4 question assessment of features including acute onset and fluctuating course, inattention, disorganized thinking, and altered level of consciousness.
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CAM Features 1 and 2, and either 3 or 4. Each of the 20 items pertains to a specific CAM feature and is coded either yes/no or correct/incorrect.
910:"Screening for Delirium via Family Caregivers: Convergent Validity of the Family Confusion Assessment Method (FAM-CAM) and Interviewer-Rated CAM" 746:
Rohatgi, Nidhi; Weng, Yingjie; Bentley, Jason; Lansberg, Maarten G.; Shepard, John; Mazur, Diana; Ahuja, Neera; Hopkins, Joseph (December 2019).
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Marcantonio, Edward R.; Ngo, Long H.; O'Connor, Margaret; Jones, Richard N.; Crane, Paul K.; Metzger, Eran D.; Inouye, Sharon K. (2014-10-21).
967:"3D-CAM: Derivation and Validation of a 3-Minute Diagnostic Interview for CAM-Defined Delirium: A Cross-sectional Diagnostic Test Study" 908:
Steis, Melinda R.; Evans, Lois; Hirschman, Karen B.; Hanlon, Alexandra; Fick, Donna M.; Flanagan, Nina; Inouye, Sharon K. (Nov 2012).
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setting. It was designed to be brief (less than 5 minutes to perform) and based on criteria from the third edition-revision of the
748:"Initiative for Prevention and Early Identification of Delirium in Medical-Surgical Units: Lessons Learned in the Past Five Years" 1466: 1324:
Grossmann, Florian F; Hasemann, Wolfgang; Graber, Andreas; Bingisser, Roland; Kressig, Reto W; Nickel, Christian H (2014-03-13).
36:. The CAM rates four diagnostic features, including acute onset and fluctuating course, inattention, disorganized thinking, and 37: 1471: 70:
shows a lower sensitivity (as judged by positive score rates in relation to estimated delirium rates) of around 30-40%.
62: 1081:"Radiochemical assay of glutathione S-epoxide transferase and its enhancement by phenobarbital in rat liver in vivo" 687:
Reynish, Emma L.; Hapca, Simona M.; De Souza, Nicosha; Cvoro, Vera; Donnan, Peter T.; Guthrie, Bruce (2017-07-27).
463:"The Confusion Assessment Method: A Systematic Review of Current Usage: CAM: A SYSTEMATIC REVIEW OF CURRENT USAGE" 270:
fluctuating course, inattention, disorganized thinking, and altered level of consciousness rated with 8 items.
1385:"Preliminary Derivation of a Nursing Home Confusion Assessment Method Based on Data from the Minimum Data Set" 801:
Corradi, John P.; Chhabra, Jyoti; Mather, Jeffrey F.; Waszynski, Christine M.; Dicks, Robert S. (2016-08-01).
434: 1446: 80: 634:"A Multi-Phase Quality Improvement Initiative for the Treatment of Active Delirium in Older Persons" 853:"The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts" 1420: 1306: 783: 669: 1412: 1404: 1365: 1347: 1298: 1290: 1251: 1216: 1167: 1159: 1108: 1100: 1061: 1043: 1004: 986: 947: 929: 890: 872: 830: 822: 775: 767: 728: 710: 661: 653: 613: 595: 554: 536: 492: 416: 408: 152:
English, Arabic, Dutch, French, German, Italian, Polish, Portuguese, Spanish, Thai, Turkish
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English, Arabic, Dutch, French, German, Italian, Polish, Portuguese, Spanish, Thai, Turkish
1396: 1355: 1337: 1282: 1243: 1206: 1198: 1149: 1139: 1092: 1051: 1035: 994: 978: 937: 921: 880: 864: 814: 759: 718: 700: 645: 603: 585: 544: 526: 482: 474: 400: 515:"Confusion assessment method: a systematic review and meta-analysis of diagnostic accuracy" 461:
Wei, Leslie A.; Fearing, Michael A.; Sternberg, Eliezer J.; Inouye, Sharon K. (May 2008).
21: 1360: 1325: 1211: 1186: 1056: 1023: 999: 966: 942: 909: 885: 852: 803:"Analysis of multi-dimensional contemporaneous EHR data to refine delirium assessments" 723: 688: 608: 573: 549: 514: 487: 462: 1384: 1202: 1455: 1400: 1270: 1247: 1096: 925: 818: 787: 673: 478: 1424: 1310: 229:
setting and does not include skip patterns. Research and clinical versions exist.
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Dosa, David; Intrator, Orna; McNicoll, Lynn; Cang, Yuwei; Teno, Joan (Jul 2007).
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Lewis; et al. (1995). "Unrecognized delirium in ED geriatric patients".
1163: 1144: 1127: 1104: 1047: 990: 933: 876: 826: 771: 714: 657: 599: 540: 412: 1342: 802: 747: 633: 1416: 1369: 1302: 1220: 1171: 1065: 1008: 951: 894: 834: 779: 732: 665: 617: 558: 496: 1255: 1024:"Comparative Accuracy and Efficiency of Four Delirium Screening Protocols" 420: 25: 1154: 531: 1039: 649: 982: 868: 1330:
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
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Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)
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English and Zambian (Bemba and Nyanja dialects available)
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Network for Investigation of Delirium: Unifying Scientists
389:"Clarifying Confusion: The Confusion Assessment Method" 235:
English, Danish, and Italian (clinical version only)
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developed to allow physicians and nurses to identify
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Shi, Qiyun; Warren; Saposnik; MacDermid (Sep 2013).
61:A large high-quality STARD-compliant diagnostic 1462:Mental disorders screening and assessment tools 1128:"Delirium in Mechanically Ventilated Patients" 291:of consciousness, and disorganized thinking. 65:published in 2019 comparing the CAM with the 8: 1389:Journal of the American Geriatrics Society 1236:The American Journal of Emergency Medicine 1079:Marniemi, J.; Parkki, M. G. (1975-09-01). 1028:Journal of the American Geriatrics Society 914:Journal of the American Geriatrics Society 638:Journal of the American Geriatrics Society 467:Journal of the American Geriatrics Society 1359: 1341: 1210: 1153: 1143: 1055: 998: 941: 884: 722: 704: 607: 589: 548: 530: 486: 87:CONFUSION ASSESSMENT METHOD ADAPTATIONS 85: 372: 519:Neuropsychiatric Disease and Treatment 846: 844: 7: 508: 506: 456: 454: 382: 380: 378: 376: 1447:Marcus Institute for Aging Research 208:assessment and cognitive testing. 14: 1203:10.1016/j.annemergmed.2013.05.003 807:Computers in Biology and Medicine 1401:10.1111/j.1532-5415.2007.01239.x 926:10.1111/j.1532-5415.2012.04200.x 819:10.1016/j.compbiomed.2016.06.013 752:The American Journal of Medicine 479:10.1111/j.1532-5415.2008.01674.x 387:Inouye, Sharon K. (1990-12-15). 1275:Internal and Emergency Medicine 38:altered level of consciousness 1: 1248:10.1016/0735-6757(95)90080-2 1191:Annals of Emergency Medicine 1097:10.1016/0006-2952(75)90080-5 764:10.1016/j.amjmed.2019.05.035 405:10.7326/0003-4819-113-12-941 971:Annals of Internal Medicine 857:Annals of Internal Medicine 393:Annals of Internal Medicine 63:randomized controlled trial 18:Confusion Assessment Method 1488: 1287:10.1007/s11739-017-1781-y 706:10.1186/s12916-017-0899-0 591:10.1186/s12916-019-1367-9 316:level of consciousness. 1145:10.1001/jama.286.21.2703 1085:Biochemical Pharmacology 93:CAM and its Adaptations 1467:Intensive care medicine 1343:10.1186/1757-7241-22-19 328:Emergency Department 307:Emergency Department 286:Emergency Department 215:English and Spanish 1472:Geriatric psychiatry 758:(12): 1421–1430.e8. 340:English and German 108:Available Languages 88: 532:10.2147/NDT.S49520 439:help.agscocare.org 435:"AGS CoCare: HELP" 191:severe delirium. 170:severe delirium. 86: 1138:(21): 2703–2710. 1091:(17): 1569–1572. 1040:10.1111/jgs.16711 1034:(11): 2572–2578. 920:(11): 2121–2126. 650:10.1111/jgs.16897 364: 363: 354:hospitalization. 44:Elements of Score 1479: 1429: 1428: 1395:(7): 1099–1105. 1380: 1374: 1373: 1363: 1345: 1321: 1315: 1314: 1266: 1260: 1259: 1231: 1225: 1224: 1214: 1182: 1176: 1175: 1157: 1147: 1123: 1117: 1116: 1076: 1070: 1069: 1059: 1019: 1013: 1012: 1002: 983:10.7326/M14-0865 962: 956: 955: 945: 905: 899: 898: 888: 869:10.7326/M13-1927 848: 839: 838: 798: 792: 791: 743: 737: 736: 726: 708: 684: 678: 677: 628: 622: 621: 611: 593: 569: 563: 562: 552: 534: 510: 501: 500: 490: 458: 449: 448: 446: 445: 431: 425: 424: 384: 89: 1487: 1486: 1482: 1481: 1480: 1478: 1477: 1476: 1452: 1451: 1438: 1433: 1432: 1382: 1381: 1377: 1323: 1322: 1318: 1268: 1267: 1263: 1233: 1232: 1228: 1184: 1183: 1179: 1125: 1124: 1120: 1078: 1077: 1073: 1021: 1020: 1016: 964: 963: 959: 907: 906: 902: 850: 849: 842: 800: 799: 795: 745: 744: 740: 686: 685: 681: 630: 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Index

diagnostic tool
delirium
healthcare
Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R)
altered level of consciousness
randomized controlled trial
4AT
here




"Clarifying Confusion: The Confusion Assessment Method"
doi
10.7326/0003-4819-113-12-941
ISSN
0003-4819
PMID
2240918
"AGS CoCare: HELP"


"The Confusion Assessment Method: A Systematic Review of Current Usage: CAM: A SYSTEMATIC REVIEW OF CURRENT USAGE"
doi
10.1111/j.1532-5415.2008.01674.x
PMC
2585541
PMID
18384586

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