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3D-CAM

2014

3D-CAM is a short structured interview with 20 core interview and observer-rated items plus two conditional supplementary items. It operationalises the CAM clinical features to assess for current delirium in hospitalised adults, including people living with dementia.

At a glance

Purpose
Episodic assessment
Population
Adult
Setting
General / acute hospital, Perioperative
Time
~3 min
Items
20
Score or threshold
Operationalised CAM algorithm

Format: The validated 3D-CAM assessment contains 20 core interview and observer-rated items covering the four diagnostic features used in the short CAM. The current official form also includes two conditional supplementary items. Administration takes about 3 minutes. The prompts, response options, feature scoring and decision rule are not reproduced here; use the linked official materials.

  • Strengths: Structured assessment in about three minutes with strong pooled diagnostic accuracy, including evidence in people living with dementia
  • Limitations: Evidence is concentrated in older medical and postoperative populations and performance still depends on training and workflow. The diagnostic 3D-CAM should not be conflated with the separately derived 3D-CAM-S severity method

Primary validation papers

9 identified diagnostic-accuracy papers

Other forms of validation are described in the evidence section. What is counted?

Large-scale clinical implementation

None identified in the scoped review.

None identified in the selected profile sources and the Penfold general-hospital review. This is not a completed search of all settings or later papers.

Training and instructions

  • 3D-CAM manual and example videos. Developer resource page with the instrument-specific manual. Check the current version and reuse terms.
  • 3D-CAM form. Public instrument material checked on 5 September 2026. Follow the source’s version and permission conditions.
  • 3D-CAM manual or instructions. Public manual or instructions checked on 5 September 2026. Follow the source’s version and permission conditions.
Start here

Tool and original sources

View the current 3D-CAM at Delirium Central. Permission is required for reproduction, so it is not reproduced here.

Open the official tool page ↗ Open project website ↗

Original and selected diagnostic-accuracy papers

  • Original paperMarcantonio ER, Ngo LH, O'Connor M, Jones RN, Crane PK, Metzger ED, et al. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Annals of internal medicine. 2014;161(8):554-61. doi: 10.7326/M14-0865. PMID: 25329203.

    This paper reports the derivation and initial validation of 3D-CAM. It reported sensitivity of 95% and specificity of 94% against an independent DSM-IV clinical assessment.

    Open PubMed ↗
  • Selected diagnostic-accuracy studyKuczmarska A, Ngo LH, Guess J, O'Connor MA, Branford-White L, Palihnich K, et al. Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU. Journal of general internal medicine. 2016;31(3):297-303. doi: 10.1007/s11606-015-3514-0. PMID: 26443577.

    This diagnostic-accuracy study evaluated 3D-CAM in two non-ICU general-medicine units at one academic medical centre against an independent DSM-IV clinical assessment. It reported sensitivity of 95% and specificity of 93% in 101 hospitalised patients aged 75 years or older.

    Open PubMed ↗
  • Selected diagnostic-accuracy studyOlbert M, Eckert S, Mörgeli R, Kruppa J, Spies CD. Validation of 3-minute diagnostic interview for CAM-defined Delirium to detect postoperative delirium in the recovery room: A prospective diagnostic study. European journal of anaesthesiology. 2019;36(9):683-687. doi: 10.1097/EJA.0000000000001048. PMID: 31306183.

    This diagnostic-accuracy study evaluated 3D-CAM in recovery room of a tertiary university hospital against a DSM-5 clinical assessment. It reported sensitivity of 100% and specificity of 88% in 176 adult elective-surgery patients; 16 postoperative-delirium cases.

    Open PubMed ↗
Pooled diagnostic-accuracy evidenceCore instrument family
Classification

Classification

Episodic assessment

A tool may belong to more than one category. Select a linked category to see other relevant profiles.

Evidence

Diagnostic-accuracy evidencePooled diagnostic-accuracy evidence

Reported sensitivity and specificity

Headline metric source

Original/source study · 2014; pmid:25329203

Denominator
201 patients; 201 assessments
Reference standard
Face-to-face clinical assessment plus record/nurse/family information and MoCA, followed by expert-panel DSM-IV adjudication
95%
Sensitivity
94%
Specificity

Original 2014 validation in 201 older medical inpatients: sensitivity was 95% and specificity 94% against expert DSM-IV adjudication. Later studies and pooled estimates are shown below; PubMed lists a published correction.

Expanded evidence profile

What the broader evidence shows

Interpretation: The 3D-CAM has strong diagnostic-accuracy evidence in older medical and postoperative populations, with pooled sensitivity about 0.92 and specificity about 0.95. Performance still depends on training, case mix and comparator, and the diagnostic 3D-CAM should not be conflated with the separate 3D-CAM-S severity measure.

Evidence snapshots

  • Original validation (2014): In 201 older medical inpatients, sensitivity was 95% and specificity 94%; in the dementia subgroup sensitivity was 96% and specificity 86%.
  • Nurse validation (2020): In 323 older inpatients assessed by 49 nurses, sensitivity was 92% and specificity 89% against a blinded neurologist DSM-5 assessment.
  • Tool-specific meta-analysis (2023): Seven studies, 1,350 patients and 2,499 assessments: pooled sensitivity 0.92 and specificity 0.95.
  • Recent multicentre validation (2025): Across 133 surgical patients and 399 paired assessments, two raters achieved sensitivity of 95% and 93% and specificity of 97% and 99%.

These results come from different populations and workflows and should not be averaged or treated as interchangeable.

8 selected PubMed-indexed papers, 2014–2025
  1. 2014Original development and validation study
    Marcantonio ER, Ngo LH, O'Connor M, Jones RN, Crane PK, Metzger ED, Inouye SK. 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Ann Intern Med. 2014;161(8):554-561. doi: 10.7326/M14-0865. PMID: 25329203.

    The developers derived the 3D-CAM from 4,598 assessments and validated it in 201 older medical inpatients against an expert DSM-IV reference assessment. Sensitivity was 95% and specificity 94%, with 96% sensitivity and 86% specificity among participants with dementia; PubMed lists a published correction to the article.

    PubMed · PMID 25329203 ↗
  2. 2016Diagnostic-accuracy study
    Kuczmarska A, Ngo LH, Guess J, et al. Detection of delirium in hospitalized older general medicine patients: a comparison of the 3D-CAM and CAM-ICU. J Gen Intern Med. 2016;31(3):297-303. doi: 10.1007/s11606-015-3514-0. PMID: 26443577.

    This random-order blinded study compared 3D-CAM and CAM-ICU with an expert reference assessment in 101 older general-medicine patients. 3D-CAM sensitivity was 95% and specificity exceeded 90%, while CAM-ICU sensitivity was 53%, with many missed cases having mild delirium.

    PubMed · PMID 26443577 ↗
  3. 2019Diagnostic-accuracy study
    Olbert M, Eckert S, Morgeli R, Kruppa J, Spies CD. Validation of the 3-minute diagnostic interview for CAM-defined delirium to detect postoperative delirium in the recovery room: a prospective diagnostic study. Eur J Anaesthesiol. 2019;36(9):683-687. doi: 10.1097/EJA.0000000000001048. PMID: 31306183.

    This recovery-room study compared the 3D-CAM with a blinded DSM-5 reference assessment in 176 postoperative patients, 16 of whom had delirium. Sensitivity was 100% and specificity 88%, but the positive predictive value was 44% because delirium prevalence was low.

    PubMed · PMID 31306183 ↗
  4. 2020Diagnostic-accuracy study
    Mu DL, Ding PP, Zhou SZ, Liu MJ, et al. Cross-cultural adaptation and validation of the 3D-CAM Chinese version in surgical ICU patients. BMC Psychiatry. 2020;20(1):133. doi: 10.1186/s12888-020-02544-w. PMID: 32204700.

    The Chinese 3D-CAM was tested in 245 surgical intensive-care patients across 647 paired assessments, including people with mild cognitive impairment. Two raters achieved sensitivity of 87.2% and 84.6% and specificity of 96.7% and 97.4% against the reference assessment.

    PubMed · PMID 32204700 ↗
  5. 2020Diagnostic-accuracy study
    Wang J, Lu S, Huang Y, et al. A nurse-administered 3-Minute diagnostic interview for CAM-defined Delirium (3D-CAM Chinese version) in hospitalized elderly patients: A validation study. Int J Nurs Stud. 2020;110:103701. doi: 10.1016/j.ijnurstu.2020.103701. PMID: 32736252.

    In the diagnostic component of this nurse-delivered study, 49 nurses assessed 323 older inpatients and 64 had delirium by a blinded neurologist DSM-5 assessment. The 3D-CAM had 92% sensitivity and 89% specificity, supporting delivery by trained ward nurses.

    PubMed · PMID 32736252 ↗
  6. 2021Clinical implementation study
    Oberhaus J, Wang W, Mickle AM, Becker J, et al. Evaluation of the 3-Minute Diagnostic Confusion Assessment Method for Identification of Postoperative Delirium in Older Patients. JAMA Netw Open. 2021;4(12):e2137267. doi: 10.1001/jamanetworkopen.2021.37267. PMID: 34902038.

    This postoperative implementation study included 299 patients and 471 concurrent interviews, comparing 3D-CAM results with clinical diagnosis and a long-form CAM comparator rather than an independent DSM reference assessment. Agreement was moderate and a positive 3D-CAM was associated with a 2.78-fold higher probability of clinical delirium diagnosis, while the authors noted possible overdiagnosis.

    PubMed · PMID 34902038 ↗
  7. 2023Systematic review and meta-analysis
    Ma Y, Liu Y, He L, et al. Diagnostic accuracy of the 3-minute diagnostic interview for CAM-defined delirium: a systematic review and meta-analysis. Age Ageing. 2023;52(5):afad074. doi: 10.1093/ageing/afad074. PMID: 37211364.

    This 3D-CAM-specific review included seven studies, 1,350 patients and 2,499 assessments from medical and perioperative settings. Pooled sensitivity was 0.92 and specificity 0.95, although repeated assessments and heterogeneous settings complicate a single patient-level interpretation.

    PubMed · PMID 37211364 ↗
  8. 2025Diagnostic-accuracy study
    Sarı S, Dilsiz P, Eker T, Şahin S, et al. Validation and Translation of the 3D-CAM to Turkish in Surgical Intensive Care Patients. Turk J Anaesthesiol Reanim. 2025;53(2):62-68. doi: 10.4274/TJAR.2025.251888. PMID: 40116457.

    This three-hospital study included 133 surgical intensive-care patients and 399 paired assessments against a blinded DSM-5 reference assessment. Two raters achieved sensitivity of 95% and 93% and specificity of 97% and 99%, providing recent independent-language validation.

    PubMed · PMID 40116457 ↗

This is a selected evidence overview, not a systematic review. It covers the diagnostic 3D-CAM rather than 3D-CAM-S and includes the original development and validation, independent language and setting validations, implementation evidence and the tool-specific meta-analysis; all eight records were checked in PubMed and DOI-bearing papers were checked in Scite on 31 August 2026. PubMed's published-correction notice for the original article is flagged.

More evidence and citation details
Full name
3D-CAM
Also known as
3-minute CAM, 3 minute diagnostic CAM
Related profiles
3D-CAM-S, 3D-DST, Raw 3D-CAM severity score, UB-CAM
Training
Use the current 3D-CAM manual and recommended training before clinical or research use.
Evidence summary
Systematic reviews and multiple diagnostic-accuracy studies
Diagnostic-accuracy evaluations
9
Reference standard
Expert panel
Reliability
;
Citation
Marcantonio ER, Ngo LH, O'Connor M, Jones RN, Crane PK, Metzger ED, Inouye SK 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study Annals of internal medicine. 2014;161(8):554-61. PMID 25329203
Download RIS ↗ Download BibTeX ↗

Primary validation studies

Distinct primary publications from the current diagnostic-accuracy audit. Reviews and repeated evaluations within one paper are not counted again. Overlapping cohorts have not all been reconciled. Read the counting rules and limitations.

Open 9 identified papers
  1. Marcantonio ER, Ngo LH, O'Connor M, Jones RN, Crane PK, Metzger ED, Inouye SK (2014). 3D-CAM: derivation and validation of a 3-minute diagnostic interview for CAM-defined delirium: a cross-sectional diagnostic test study. Annals of internal medicine.

    Reference category: independent clinical reference.

  2. Kuczmarska A, Ngo LH, Guess J, O'Connor MA, Branford-White L, Palihnich K, Gallagher J, Marcantonio ER (2016). Detection of Delirium in Hospitalized Older General Medicine Patients: A Comparison of the 3D-CAM and CAM-ICU. Journal of general internal medicine.

    Reference category: independent clinical reference.

  3. Olbert M, Eckert S, Mörgeli R, Kruppa J, Spies CD (2019). Validation of 3-minute diagnostic interview for CAM-defined Delirium to detect postoperative delirium in the recovery room: A prospective diagnostic study. European journal of anaesthesiology.

    Reference category: independent clinical reference.

  4. Mu DL, Ding PP, Zhou SZ, Liu MJ, Sun XY, Li XY, Wang DX (2020). Cross-cultural adaptation and validation of the 3D-CAM Chinese version in surgical ICU patients. BMC psychiatry.

    Reference category: independent clinical reference.

  5. Wang J, Lu S, Huang Y, Ji M, Yang F, Zhang Y, Liu H, Li F, Wu W, Bi J, Jin X, Wu Y (2020). A nurse-administered 3-Minute diagnostic interview for CAM-defined Delirium (3D-CAM Chinese version) in hospitalized elderly patients: A validation study. International journal of nursing studies.

    Reference category: independent clinical reference.

  6. Ji M, Wang J, Yang X, Huang Y, Xiao Y, Wu Y (2021). Validation of the 3-minute diagnostic interview for CAM-defined Delirium in Chinese older adults. Geriatric nursing (New York, N.Y.).

    Reference category: independent clinical reference.

  7. Aldwikat RK, Manias E, Holmes A, Tomlinson E, Nicholson P (2022). Validation of Two Screening Tools for Detecting Delirium in Older Patients in the Post-Anaesthetic Care Unit: A Diagnostic Test Accuracy Study. International journal of environmental research and public health.

    Reference category: other comparator or secondary accuracy evidence.

  8. Sarı S, Dilsiz P, Eker T, Şahin S, Şahin MD, Doğan B, Özçiftçi P, Özcan H, Dostbil A, İyisoy MS, Turan O, Taşkın F, Kyenshilik D, Kazaylek M, İnce İ, Turan A (2025). Validation and Translation of the 3D-CAM to Turkish in Surgical Intensive Care Patients. Turkish journal of anaesthesiology and reanimation.

    Reference category: independent clinical reference.

  9. de Burlo R, Robles A, Salazar S, Yang J, MacDonald S, Luo A, Myers O, Wylie W, Quinn DK (2025). Validation of Cerebral State Monitor Frequency Power Ratios for Detection of Delirium. Journal of the Academy of Consultation-Liaison Psychiatry.

    Reference category: independent clinical reference.

Copyright and reuse
Version
3D-CAM version 5.7
Rights holder
Hospital Elder Life Program (copyright); Aging Brain Center (permissions administrator)
Licence
ALL-RIGHTS-RESERVED-PERMISSION-REQUIRED
Information checked
2026-07-19

Instrument-specific terms apply. See the access and copyright policy or send a correction.

Base clinical review: 2026-08-31. Instrument description source check: 2026-09-05. Scope and limitations.