Table 1.

Tips for Assessing Inattention (Feature 2) using the CAM-ICU

Auditory attention test (sufficient to determine inattention in most patients)

Typically a string of ten letters (e.g., “S-A-V-E-A-H-A-A-R-T” or “A-B-A-D-B-A-D-A-A-Y”) Can be modified for different languages (e.g., “A-N-A-N-A-S-B-A-U-M”, German for pineapple) Character based languages (e.g., China, Japan, Korea) can use a string of numbers (e.g, 1-2-1-3-4-2-1-2-6-1) If the patient incorrectly squeezes >2 times, then s/he is inattentive. This includes patients who squeeze on no letters, those who squeeze on every letter, and those who stop squeezing after a few letters.

Visual attention test

Typically reserved for ~5% of needing a more rigorous “stress test” of attention (e.g., clinician is highly suspicious that delirium is present but the patient is borderline on the auditory attention test) During the visual test the patient is shown and asked to remember 5 pictures. The patient is then shown 10 pictures, and asked to indicate whether a picture was previously seen. (instructions & picture packets available to be printed at www.icudelirium.org/assessment). If the patient makes >2 mistakes, then s/he is inattentive.

CAM-ICU, Confusion Assessment Method for the Intensive Care Unit.