Which bedside tool is commonly used to screen for delirium in hospitalized patients?

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Delirium screening at the bedside is best done with a tool that directly tests the defining features of delirium: acute onset with fluctuations, inattention, and an associated disturbance in cognition that can involve disorganized thinking or altered level of consciousness. The Confusion Assessment Method is designed for this purpose. It quickly guides the clinician through four elements and requires both acute onset with fluctuating course and inattention, plus either disorganized thinking or an altered level of consciousness, to identify delirium. This makes CAM particularly effective in hospitalized patients, where delirium can fluctuate and is easy to miss if you rely on general cognitive screens.

Why this tool fits so well is that it focuses on attention and the acute change in mental status, which are central to delirium. It’s validated for bedside use by trained staff and can be performed in a short amount of time, which is crucial in busy hospital settings. In contrast, tools like the Mini-Mental State Examination or the Montreal Cognitive Assessment assess baseline cognitive function and chronic impairment (dementia) rather than the abrupt, fluctuating changes that signal delirium. They may miss delirium or confound it with preexisting cognitive deficits. The Short Portable Mental Status Questionnaire serves a similar purpose in broad cognitive screening but does not specifically capture the hallmark features of delirium, particularly the acute onset and fluctuations.

For nonverbal or intubated patients, a CAM-ICU variant provides the same focused approach in those settings, maintaining the emphasis on attention and acute change.