Quantify delirium intensity to predict patient outcomes.
Guidelines & Evidence
Clinical Details
Section 1
When to Use
Clinical Utility
Quantification of delirium intensity in hospitalized older adults.
Prediction of hospital length of stay (LOS), mortality, and nursing home placement.
Monitoring response to delirium management interventions.
Identification of patients at high risk for functional and cognitive decline.
Form Selection
This tool implements the CAM-S Short Form (4 items), which provides a rapid (5-minute) assessment highly correlated with clinical outcomes.
Section 2
Formula & Logic
Scoring Logic (Short Form)
Acute Onset / Fluctuation
Absent (0) or Present (1)
Inattention
Absent (0), Mild (1), or Marked (2)
Disorganized Thinking
Absent (0), Mild (1), or Marked (2)
Altered Consciousness
Absent (0), Mild (1), or Marked (2)
Severity Categories
Score 0
None
Score 1
Low
Score 2
Moderate
Score 3–7
High
Section 3
Pearls/Pitfalls
Prognostic Value
Dose-response relationship: As CAM-S scores increase, so do healthcare costs and adverse outcomes.
Length of Stay: Scores of 3-7 are associated with an adjusted mean LOS of 12.7 days compared to 6.5 days for a score of 0.
Mortality: High severity (3-7) correlates with a 3.3x increased relative risk of death within 90 days.
Nuance
The CAM-S quantifies symptom intensity. It is intended to be used in addition to the original CAM algorithm, as it does not provide a binary diagnosis on its own.
Section 4
Next Steps
Management Strategy
01
Assess for reversible causes (infections, metabolic derangements, medications).
02
Implement non-pharmacologic protocols (reorientation, sleep hygiene, early mobilization).
03
High Severity: Consider heightened monitoring and family involvement to mitigate falls and injury risk.
Section 5
Evidence Appraisal
Validation Reference
The CAM-S: Development and Validation of a New Scoring System for Delirium Severity in 2 Cohorts.
Inouye SK et al. • Ann Intern Med.. 2014;Validated in 1,219 patients age ≥70. Demonstrated strong predictive validity for LOS, costs, and mortality.
