Confusion is not a diagnosis — it is a symptom with three common explanations treated completely differently. Run the CAM logic yourself, separate delirium from dementia and depression at the bedside, hunt the cause with PINCH ME, and score mood and suicide risk. The single question that separates them: what was this person like two weeks ago?
Confusion Assessment Method
Tick each feature that is present in your patient. The rule is not “three out of four” — watch the logic on the right change as you tick.
Screen at least once a shift in any at-risk patient, and any time the family says “that is not how she normally is.” The ICU version (CAM-ICU) uses RASS plus a picture and letter task, so an intubated patient can be screened without speaking.
Which one is this?
Positive CAM — now find the causeMrs Rowe, 81. Two days after a right hip fracture, one day after surgery. At 0800 she was alert, oriented ×4 and joking with her daughter. It is now 1500 and she is oriented to person and place only, says the year is 1998, cannot recite the months backward, and reports seeing children at the window. T 38.1 °C, HR 110, BP 102/58, RR 24, SpO2 92 percent on room air. Urinary catheter placed before surgery; urine cloudy and strong smelling. She is on scheduled oxycodone and has not opened her bowels since admission.
Select every contributor you can find in this history
Then check — each correct pick is tagged with its letter in PINCH ME.
PHQ-2 — over the last two weeks
Each item is scored 0 (not at all) to 3 (nearly every day).
Follow-up scores, if you have them
Ask directly and plainly: “Are you having thoughts of killing yourself?” Asking does not plant the idea and does not increase risk — that is a myth, and the evidence contradicts it.
CAM negativeTick the features present on the left.
Delirium, dementia or depression?Read the patient, then choose.