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Free tool · Scored assessment · ICU

CAM-ICU Delirium Screen.

The standard bedside check for delirium in the ICU — including patients who are intubated and can't talk. It walks the four features and applies the algorithm: a patient is CAM-ICU positive when there's an acute change or fluctuation (Feature 1) and inattention (Feature 2) plus either an altered level of consciousness (Feature 3) or disorganized thinking (Feature 4). This tool encodes the logic and the cutoffs; administer the actual attention and thinking tests from the official worksheet. Validated by Ely 2001.

Walk the four features

First, the patient must be arousable. Get the official test materials (the attention letters/pictures and the yes-or-no questions) from the Vanderbilt ICU Delirium worksheet and administer them at the bedside, then record the results here.

RASS
Current RASS (arousal gate)
CAM-ICU can only be done if the patient is arousable to voice — a RASS of −3 or higher (at −3, proceed only if the patient responds to your voice, not only to physical stimulation). At −4/−5 the screen is "unable to assess."
1
Acute change or fluctuating course
Is there an acute change from the patient's baseline mental status, or has mental status fluctuated in the past 24 hours (including a change in RASS or GCS)?
2
Inattention
Administer the attention test (the letters or pictures task on the worksheet). 3 or more errors = inattention present.
3
Altered level of consciousnessfrom RASS
Feature 3 is present whenever the current RASS is anything other than 0 (alert and calm). This fills in automatically from the RASS you selected above.
4
Disorganized thinking
Administer the yes-or-no questions plus the command from the worksheet. More than 1 error (2 or more) = disorganized thinking present.

Select the RASS and work through the features to see the result.

The algorithm [1]

CAM-ICU is positive (delirium present) when:

Feature 1 (acute change / fluctuation) AND Feature 2 (inattention) AND ( Feature 3 (altered LOC, RASS ≠ 0) OR Feature 4 (disorganized thinking) ).

If Feature 1 or Feature 2 is absent, the screen is negative. If the patient is at RASS −4 or −5, the screen is "unable to assess" — re-check when the patient is more awake. CAM-ICU is a screen performed alongside RASS (delirium monitoring per the SCCM PADIS bundle).[2]

Disclaimer: Educational tool only — not a clinical decision-support device, not a diagnosis, and not a substitute for your assessment, the provider's evaluation, or your unit's delirium protocol. This tool encodes the CAM-ICU algorithm and cutoffs; you must administer the validated attention and disorganized-thinking tests from the official worksheet to score Features 2 and 4 correctly. A negative screen does not rule out delirium over the shift — re-screen at least once per shift and with any change. Treat the cause (look for reversible contributors — infection/sepsis, hypoxia, metabolic disturbance, pain, withdrawal, urinary retention or constipation, and newly started medications), minimize deliriogenic meds, and use non-pharmacologic measures per protocol. Enter de-identified values only; nothing is stored or transmitted.

References

  1. Ely EW, Inouye SK, Bernard GR, et al. Delirium in mechanically ventilated patients: validity and reliability of the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). JAMA. 2001;286(21):2703–2710. PMID: 11730446. (Four-feature CAM-ICU; positive = Features 1 + 2 + [3 or 4]; inattention ≥3 errors; disorganized thinking >1 error.) Official worksheet & training materials: icudelirium.org (Vanderbilt; © used here by reference only).
  2. Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). Crit Care Med. 2018;46(9):e825–e873. PMID: 30113379. (Routine delirium monitoring with a validated tool such as CAM-ICU, paired with RASS.)
  3. Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale. Am J Respir Crit Care Med. 2002;166(10):1338–1344. PMID: 12421743. (RASS; Feature 3 = current RASS other than 0; CAM-ICU requires RASS ≥ −3.)

The CAM-ICU algorithm logic and cutoffs were transcribed from the validation literature. The attention/thinking test materials are the copyrighted CAM-ICU worksheet (Vanderbilt) — obtain and administer them from icudelirium.org. Your unit's delirium protocol takes precedence.

Pairs well with

Keep the right tools close.

RASS →

Score the sedation level first — CAM-ICU needs a RASS ≥ −3 and uses it for Feature 3.

ICU Brain Sheet →

Keep the whole picture — drips, lines, neuro checks — in one place.

Medication Lookup →

Check which meds on the MAR are deliriogenic and worth a second look.