The Brief Confusion Assessment Method (bCAM) is a delirium assessment that takes approximately 1 to 2 minutes to perform. If performed algorithmically using the bCAM flowsheet, it can be performed in less than one minute in many patients. The bCAM uses the CAM algorithm and has four features: (1) altered mental status/fluctuating course, (2) inattention, (3) altered level of consciousness, and (4) disorganized thinking. Like the CAM, a patient must be inattentive (cardinal feature of delirium) in order to be bCAM positive. The bCAM is a modified CAM-ICU and these modifications were designed to improve sensitivity in non-critically ill patients. It uses objective testing with prespecified cutoffs to determine the presence of inattention and disorganized thinking. Inattention is assessed for by asking the patient to recite the months backwards from December to July. Disorganized thinking is tested for by asking four yes/no questions and asking the patient to perform a simple command.
In older emergency department patients, the bCAM is 84% sensitive and 96% specific when performed by a physician and 78% sensitive and 97% specific when performed by a non-physician (Han et al. Ann Emerg Med. 2013). The bCAM’s diagnostic performance appears to be similar in older patients who are admitted to the hospital.
The bCAM is now part of the Geriatric Emergency Medicine Guidelines released in October 2013.
For additional details on how to perform the bCAM and practice videos,see the links below:
bCAM Training Manual
How to Perform the bCAM Video
bCAM Patient Demonstration
bCAM Practice Videos
Feel free to download the bCAM flowsheet and print it prior to watching these practice videos.