bCAM: Brief Confusion Assessment Method

2013

bCAM is a brief CAM-family assessment developed for older emergency-department patients. It may be used alone or within a locally selected workflow.

At a glance

Purpose: Episodic assessment
Population: Adult
Setting: Emergency department
Time: <2 min
Items: 4
Score or threshold: Feature-based CAM-family classification; see the authorised materials.

Format: A brief emergency-department CAM-family assessment combining a short cognitive assessment with four clinical feature ratings. It is often used after a sensitive first-step screen; tasks and decision logic are not reproduced here.

Strengths: Brief, structured diagnostic assessment with consistently high specificity in emergency-care studies
Limitations: Usually more specific than sensitive, with lower sensitivity in routine care; the bCAM is distinct from the separate DTS first-stage screen, and no result is definitive on its own

Training and instructions

bCAM training manual and instructions. Public ICU Delirium resource directory. Open the resource with this tool’s name; versions are listed separately.
bCAM form. Public instrument material checked on 5 September 2026. Follow the source’s version and permission conditions.
bCAM manual or instructions. Public manual or instructions checked on 5 September 2026. Follow the source’s version and permission conditions.

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Tool and original sources

A source for the tool or its access information is linked below. Check the version and current terms before use, copying or adaptation.

View the tool ↗ Official information and permissions ↗

Original and selected diagnostic-accuracy papers

Original paperHan JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Annals of emergency medicine. 2013;62(5):457-465. doi: 10.1016/j.annemergmed.2013.05.003. PMID: 23916018.
This paper reports the original validation of bCAM. It is the main source for the method, its intended use and the evidence available at publication.
Open PubMed ↗
Selected diagnostic-accuracy studyHendry K, Quinn TJ, Evans J, Scortichini V, Miller H, Burns J, et al. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age and ageing. 2016;45(6):832-837. doi: 10.1093/ageing/afw130. PMID: 27503794.
This diagnostic-accuracy study evaluated bCAM in geriatric medical assessment unit of an urban teaching hospital against a DSM-5 clinical assessment. It reported sensitivity of 70.3% and specificity of 91.4% in 387 patients with complete bCAM data within a 500-patient consecutive cohort.
Open PubMed ↗
Selected diagnostic-accuracy studyBaten V, Busch HJ, Busche C, Schmid B, Heupel-Reuter M, Perlov E, et al. Validation of the Brief Confusion Assessment Method for Screening Delirium in Elderly Medical Patients in a German Emergency Department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2018;25(11):1251-1262. doi: 10.1111/acem.13449. PMID: 29738102.
This diagnostic-accuracy study evaluated bCAM in german interdisciplinary high-volume emergency department against a DSM-5 clinical assessment. It reported sensitivity of 65.2% and specificity of 93.8% in 288 non-surgical medical patients aged 70 years or older.
Open PubMed ↗

Multiple DTA studies identifiedCore instrument family

Classification

Episodic assessment

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

Evidence

Diagnostic-accuracy evidenceMultiple DTA studies identified

Reported sensitivity and specificity

Headline metric source

Original/source study · 2013; pmid:23916018

Denominator: 406 patients
Reference standard: Independent psychiatrist DSM-IV-TR assessment within three hours

78–84%

Sensitivity

96–97%

Specificity

Original 2013 validation in 406 emergency-department patients: physician sensitivity/specificity 84.0%/95.8% and research-assistant 78.0%/96.9% against psychiatrist DSM-IV-TR assessment within three hours. Do not combine these bCAM estimates with the separate DTS results.

Expanded evidence profile

What the broader evidence shows

Interpretation: The bCAM is a brief diagnostic assessment rather than an ultra-brief case-finding question. Across emergency and hospital studies it is usually more specific than sensitive, so a positive result can be useful for ruling delirium in, but a negative result does not safely rule delirium out; performance in routine practice is lower than in the original research conditions.

Evidence snapshots

Original emergency-department study (2013): Physician sensitivity was 84.0% and specificity 95.8%; research-assistant sensitivity was 78.0% and specificity 96.9%.
Geriatric medical inpatients (2016): In 500 consecutive admissions, bCAM sensitivity was 70.3% and specificity 91.4%.
Routine German emergency care (2018): In 288 older nonsurgical patients, sensitivity was 65.2% and specificity 93.8%.
Palliative-care pilot (2019): In 36 veterans, sensitivity was 80% and specificity 87%, with wide confidence intervals.

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

6 selected PubMed-indexed papers, 2013–2024

2013Original validation study
Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, et al. Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Ann Emerg Med. 2013;62(5):457-465. doi: 10.1016/j.annemergmed.2013.05.003. PMID: 23916018.
This prospective study enrolled 406 emergency-department patients aged 65 years or older, including 50 with delirium, and compared independent physician and research-assistant bCAM ratings with a psychiatrist DSM-IV-TR assessment within three hours. Sensitivity was 84.0% and 78.0% and specificity 95.8% and 96.9% for the two raters, establishing high rule-in value under trained research conditions.
PubMed · PMID 23916018 ↗
2016Systematic review
Mariz J, Costa Castanho T, Teixeira J, Sousa N, Correia Santos N. Delirium Diagnostic and Screening Instruments in the Emergency Department: An Up-to-Date Systematic Review. Geriatrics (Basel). 2016;1(3):22. doi: 10.3390/geriatrics1030022. PMID: 31022815.
This emergency-department systematic review identified seven delirium instruments and described the paired DTS-bCAM strategy among the promising brief approaches. It did not provide a bCAM-specific pooled estimate, so its main contribution is contextual rather than a new accuracy denominator.
PubMed · PMID 31022815 ↗
2016Diagnostic-accuracy study
Hendry K, Quinn TJ, Evans J, Scortichini V, Miller H, Burns J, et al. Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age Ageing. 2016;45(6):832-837. doi: 10.1093/ageing/afw130. PMID: 27503794.
This routine-practice study evaluated five brief tools in 500 consecutive geriatric medical inpatients against elderly-care physicians' clinical diagnosis. For definite delirium, bCAM sensitivity was 70.3% and specificity 91.4%, showing lower sensitivity outside the original emergency-department study.
PubMed · PMID 27503794 ↗
2018Diagnostic-accuracy study
Baten V, Busch HJ, Busche C, Schmid B, Heupel-Reuter M, Perlov E, et al. Validation of the Brief Confusion Assessment Method for Screening Delirium in Elderly Medical Patients in a German Emergency Department. Acad Emerg Med. 2018;25(11):1251-1262. doi: 10.1111/acem.13449. PMID: 29738102.
Emergency physicians used the German bCAM during routine care in 288 nonsurgical patients aged 70 years or older, 46 of whom met a DSM-5 criterion standard. Sensitivity was 65.2% and specificity 93.8%; missed cases often lacked altered consciousness or disorganised thinking on the bCAM algorithm.
PubMed · PMID 29738102 ↗
2019Diagnostic-accuracy study
Wilson JE, Boehm L, Samuels LR, Unger D, Leonard M, Roumie C, et al. Use of the brief Confusion Assessment Method in a veteran palliative care population: A pilot validation study. Palliat Support Care. 2019;17(5):569-573. doi: 10.1017/S1478951518001050. PMID: 30887938.
This blinded pilot compared bCAM with DSM-5 assessment within 30 minutes in 36 hospitalised veterans seen by palliative care, 27% of whom had delirium. Sensitivity was 80% and specificity 87%, but the small sample produced wide confidence intervals and needs replication.
PubMed · PMID 30887938 ↗
2024Systematic review and meta-analysis
Carpenter CR, Lee S, Kennedy M, Arendts G, Schnitker L, Eagles D, et al. Delirium detection in the emergency department: A diagnostic accuracy meta-analysis of history, physical examination, laboratory tests, and screening instruments. Acad Emerg Med. 2024;31(10):1014-1036. doi: 10.1111/acem.14935. PMID: 38757369.
This diagnostic-accuracy review included 27 emergency-department studies and compared multiple approaches to identifying delirium in adults aged 60 years or older. It judged bCAM useful for ruling delirium in, while emphasising that its quantitative evidence remained based on single-centre studies rather than a robust tool-specific pooled estimate.
PubMed · PMID 38757369 ↗

This is a selected evidence overview, not a systematic review. Six papers were prioritised to retain the original validation, later routine-practice and palliative-care studies, and the strongest relevant reviews; all six records were checked in PubMed and Scite on 30 August 2026, and no selected record surfaced under the retraction, concern, correction or erratum filters used.

More evidence and citation details

Full name: Brief Confusion Assessment Method
Also known as: bCAM
Related profiles: DTS, DTS/bCAM combination
Evidence summary: Systematic reviews and multiple diagnostic-accuracy studies; no robust tool-specific pooled estimate
Diagnostic-accuracy evaluations: 5
Reference standard: DSM-IV-TR (psychiatrist)
Reliability: ;
Real-world use: In one large report, completion ranged from 12% in labour/delivery to 98% on medical services during phased implementation; setting and implementation stage both differed. (Penfold 2024)
Citation: Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, Graves AJ, Storrow AB, Shuster J, Ely EW Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method Annals of emergency medicine. 2013;62(5):457-465. PMID 23916018

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 5 identified papers

Han JH, Wilson A, Vasilevskis EE, Shintani A, Schnelle JF, Dittus RS, Graves AJ, Storrow AB, Shuster J, Ely EW (2013). Diagnosing delirium in older emergency department patients: validity and reliability of the delirium triage screen and the brief confusion assessment method. Annals of emergency medicine.
Reference category: independent clinical reference.
Han JH, Wilson A, Graves AJ, Shintani A, Schnelle JF, Ely EW (2016). A quick and easy delirium assessment for nonphysician research personnel. The American journal of emergency medicine.
Reference category: independent clinical reference.
Hendry K, Quinn TJ, Evans J, Scortichini V, Miller H, Burns J, Cunnington A, Stott DJ (2016). Evaluation of delirium screening tools in geriatric medical inpatients: a diagnostic test accuracy study. Age and ageing.
Reference category: independent clinical reference.
Baten V, Busch HJ, Busche C, Schmid B, Heupel-Reuter M, Perlov E, Brich J, Klöppel S (2018). Validation of the Brief Confusion Assessment Method for Screening Delirium in Elderly Medical Patients in a German Emergency Department. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.
Reference category: independent clinical reference.
Wilson JE, Boehm L, Samuels LR, Unger D, Leonard M, Roumie C, Ely EW, Dittus RS, Misra S, Han JH (2019). Use of the brief Confusion Assessment Method in a veteran palliative care population: A pilot validation study. Palliative & supportive care.
Reference category: independent clinical reference.

Version: CIBS-hosted bCAM flowsheet
Information checked: 2026-07-19

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

Base clinical review: 2026-08-30. Instrument description source check: 2026-09-05. Scope and limitations.