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Printed on 7/20/2026
For informational purposes only. This is not medical advice.
CAM-S extends Confusion Assessment Method logic to quantify delirium severity. It is used clinically and in research to monitor delirium symptom burden trends and treatment response.
Formula: CAM-S total is a summed delirium-severity score (commonly represented on 0-19 range).
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CAM-S is a severity scoring extension of the standard CAM. It should only be applied in patients who have been assessed using the CAM algorithm. The severity score quantifies how severe the features are, not whether delirium is present.
The long form rates 10 CAM features on a multi-point scale for a total of 0–19. The short form rates 4 features (acute onset/fluctuation, inattention, disorganised thinking, altered level of consciousness) on a 0–7 scale. Each feature is scored based on severity rather than a simple yes/no.
Record CAM-S at each delirium assessment interval. Increasing scores indicate worsening delirium burden; decreasing scores indicate improvement. The trajectory of CAM-S over days is more clinically meaningful than any single measurement.
Geriatricians, hospitalists, and inpatient nurses
Serial CAM-S scoring documents whether a patient's delirium is worsening, stable, or improving, informing decisions about treatment escalation or step-down.
Clinical researchers and trial coordinators
CAM-S provides a continuous severity outcome measure for delirium intervention trials, offering greater statistical power than the binary CAM diagnosis (present/absent) as a primary or secondary endpoint.
Surgical teams and post-anaesthetic care nurses
After surgery, CAM-S tracks the trajectory of post-operative delirium — typically peaking at 24–48 hours and resolving over days — helping teams gauge whether natural resolution is occurring or intervention is needed.
Psychiatrists and geriatric consultation teams
When pharmacological or non-pharmacological delirium treatments are initiated, CAM-S quantifies the degree of symptomatic response, providing objective data to guide medication titration or alternative strategies.
Geriatricians and palliative care teams
Higher cumulative CAM-S scores during hospitalisation predict worse outcomes including longer stay, greater functional decline, nursing home placement, and mortality, informing goals-of-care discussions.
Do not use CAM-S to diagnose delirium — it is not designed for this purpose. The CAM four-feature diagnostic algorithm determines whether delirium is present; CAM-S then grades its severity. Applying CAM-S without a CAM diagnosis is methodologically incorrect.
The CAM-S short form (0–7) is practical for daily clinical monitoring and is validated for predicting outcomes. The long form (0–19) provides more granular severity detail and is preferred for research endpoints. Use the form that matches your clinical or research purpose.
Research shows that cumulative CAM-S burden (area under the severity curve across days) is a stronger predictor of functional decline and mortality than peak or admission score. Track and document scores each assessment cycle.
Delirium fluctuates. CAM-S assessed during a lucid interval may dramatically underestimate actual burden. Score during observed periods of confusion when possible, and use caregiver/nurse observations from the full preceding interval.
CAM-S severity often worsens at night (sundowning). Document time of assessment and sleep-wake patterns alongside scores. This contextual data strengthens the interpretability of serial severity measurements.
Of the four short-form features, altered level of consciousness (RASS other than alert) carries the highest prognostic weight. Patients with high alertness disturbance scores have consistently worse outcomes in validation studies.
Inter-rater reliability in CAM-S depends on consistent application of feature definitions. Regular training, case review sessions, and clear rating anchors improve reliability across nursing shifts and clinical teams.
Persistent high CAM-S scores at the time of discharge planning suggest ongoing delirium burden and heightened risk of post-discharge adverse events. Consider delaying discharge or arranging intensive community monitoring for patients with unresolved severity.
CAM-S has validation evidence as a practical delirium severity metric linked to clinical outcomes.
Higher CAM-S totals indicate greater delirium symptom burden and support intensified monitoring/management.
Use when delirium severity tracking is needed in inpatient or consultation settings.
Scoring reliability depends on trained assessors and consistent application of CAM feature definitions.
Disclaimer: This tool is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health.
April 21, 2026 · v1.0.0
Added CAM-S severity tool metadata with baseline changelog and review/version fields.
Screen for delirium using the CAM (Confusion Assessment Method). Gold standard with ~94% sensitivity and ~89% specificity. Requires acute onset + inattention, plus disorganized thinking or altered consciousness.
OpenGeriatricsA rapid positive/negative delirium screen adapted from CAM logic for acute-care workflows.
OpenGeriatricsA structured delirium severity instrument with higher scores reflecting greater symptom burden.
OpenGeriatricsA 10-domain delirium severity scale (0-30) commonly using cutoff around >=13 for delirium signal.
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