VE-CAM-S — Visual EEG Confusion Assessment Method Severity

What this tool is and how to interpret its evidence

VE-CAM-S is a visually scored EEG scale for grading acute encephalopathy across the clinical spectrum from delirium to coma. Unlike E-CAM-S, it does not depend on automated quantitative feature extraction. A clinician identifies specified patterns on a standard EEG and combines weighted findings into a total from 0 to 20. Lower-weight findings include abnormalities of sleep transients, slowing, rhythmic activity, voltage and periodic discharges; intermittent attenuation receives greater weight, while predefined severe encephalopathy patterns receive the maximum score. Higher totals indicate greater physiological severity. The scale does not establish delirium by itself and is not a substitute for clinical assessment.

Tesh and colleagues prospectively studied 404 adult inpatients undergoing clinical EEG at one academic centre: 132 had neither delirium nor coma, 143 had delirium and 129 had coma. The model was developed using nested five-fold cross-validation. VE-CAM-S correlated with CAM-S long-form severity at 0.67. It achieved an area under the curve of 0.85 when contrasting CAM-S zero with CAM-S four or above and was associated with in-hospital mortality, three-month mortality and functional status at discharge.

The evidence remains developmental. EEG was ordered for clinical reasons, so the cohort is not representative of unselected hospital patients. Most participants were assessed only once, some clinical ratings were not closely contemporaneous with the scored EEG epoch, and routine and long-term recordings were mixed. The scale also grades coma and severe encephalopathy rather than specifically identifying delirium aetiology. It belongs in the emerging physiological register and should be described as requiring EEG acquisition and trained interpretation.