Background: Clinical tests for confusion in medically ill patients are frequently burdensome
and difficult to use. Available tests lack portability and tend to be shunned in clinical practice
by physicians.
Objective: To develop a simple, sensitive bedside test for confusion.
Design: Prospective comparison study.
Setting: An in-patient palliative medicine unit in a large urban hospital.
Patients: Thirty-one consecutive patients admitted to the unit.
Intervention: None.
Measurements: A 2-minute screening test, the Bedside Confusion Scale (BCS), which utilizes
an observation of level of consciousness at the time of clinical interaction, followed by
a timed task of attention, was administered to 31 consecutively admitted patients. The results
were compared to a previously validated test, the Confusion Assessment Method (CAM). The
BCS and the CAM were scored in standardized fashion and results of the two populations
compared. Demographic and clinical characteristics of the patient population, along with the
Karnofsky performance scores (KPS) and neurological findings were registered.
Results: Using the CAM as the reference standard, the sensitivity of the BCS was 100%.
Worsening KPS and more abnormalities on neurological examination were seen across normal
(BCS = 0), borderline (BCS = 1), and abnormal (BCS ≥ 2) groups (p > 0.01, trend test).
Conclusions: In an in-patient palliative medicine population, the BCS correlates with the
previously validated CAM and exhibits high sensitivity, an essential quality of a useful
screening test.
