delirium caused by somatic factors is a widespread and dangerous problem associated with the aging of the population .
it has been reported that consciousness disorders are experienced by 10 - 15% of patients on general wards and up to 50% of patients admitted emergently to geriatric wards .
the frequent occurrence of delirium stems from the commonness and number of risk factors for this complication , which include , among others : old age , organic injury of the central nervous system , alcoholism , malnutrition , chronic somatic diseases , chronic pain and analgesic treatment , long - term insomnia , electrolyte disorders , blood loss , dehydration , cognitive impairments , depression , metabolic disorders , use of psychoactive agents , immobility , urinary catheterization , and numerous factors associated ( directly or indirectly ) with surgical procedures [ 14 ] .
one - year mortality of delirium in the population of intensive care unit patients is estimated to be around 40% [ 5 , 6 ] .
one should keep in mind that , although qualitative disorders of consciousness are reversible and transient , they directly precede the patient 's death in 88% of cases . persisting symptoms of delirium result in growing motor agitation , disorganization , and anxiety , which increases
the risk of injury or self - harm , necessitates parenteral nutrition and the maintenance of water balance , and impedes cooperation , thus worsening the course and prognosis of the underlying disease .
consciousness disorders are believed to be among the most challenging diagnostic problems and the most difficult therapeutic problem among psychotic disorders .
differential diagnosis typically considers dementia as well as maniacal , paranoid , and delusional syndromes .
a particular diagnostic challenge is presented by hypoactive delirium , which is often confused with depression , depressive stupor , catatonia , or apathetic - abulic syndromes .
retrospective studies state that this form of delirium with poor motor activity is observed in the decided majority of cases of delirium in old patients ; its frequency correlates with the deterioration of the patient 's general condition .
these data indicate an obvious need for improving the diagnostics of consciousness disorders on somatic wards , especially those employing surgical procedures . in 1990 ,
a new diagnostic tool for mid - level medical personnel was developed ; the purpose of the confusion assessment method ( cam ) is the early detection of somatically induced delirium .
numerous studies conducted over the period of 16 years established cam 's position as an effective standardized diagnostic tool ; its sensitivity was estimated at 94 - 100% , specificity : 90 - 95% , positive predictive value : 91 - 94% , and negative predictive value : 90 - 100% .
therefore , the cam questionnaire had been translated into 10 languages by 2008 ; it is widely used in japan , germany , finland , denmark , france , italy , spain , portugal , turkey , china , and other countries .
the aim of this article is to present the polish version of this screening diagnostic tool .
the cam questionnaire consists of 9 points with questions verifying the presence of : acute changes in mental status , attention disorders , disorganized thinking , altered level of consciousness , disorientation , memory impairment , perceptual disturbance , psychomotor agitation or retardation , and sleep - wake cycle disturbances .
the questions require the respondent to evaluate the severity and dynamics of the symptoms ; space is also provided for descriptive comments .
most questions pertain to information that can be acquired during a single patient examination ; answers to the first and last question require information concerning the patient 's stay , which can be gathered from the patient 's records or the attending medical personnel .
the preliminary diagnosis of delirium only requires answers to the first five questions , constituting the so - called short form of cam . in order to interpret the questionnaire 's results ,
it is necessary to be acquainted with the scoring manual , which has also been translated in this article .
the aim of the authors was to provide a translation that would correspond to the intentions of the questionnaire 's original creators to the largest degree possible .
therefore , the original authors were invited to actively cooperate on the project . after receiving approval from professor sharon k. inouye ,
the director of the aging brain center , the first stage of work on the translation began : two independent translation groups were formed , each consisting of three physicians , including one psychiatrist .
the first group translated the original text into polish , while the second group translated the new polish text back into english without knowing the original version .
subsequently , the return translation was sent to the authors of the original questionnaire . based on their concerns and suggestions ,
the final version was modified twice before receiving full approval of the original questionnaire 's authors .
the new polish version of cam was accepted for publication among the other official translations on the help webpage : ( http://www.hospitalelderlifeprogram.org/uploads/disclaimers/cam_polish.pdf ) .
apart from cam , other tools for consciousness disorder screening are used around the world , including the delirium symptom interview ( dsi ) , the neecham confusion scale , the delirium observation screening ( dos ) scale , the cognitive test for delirium ( ctd ) , and the descard tool used in poland . among these tools ,
evaluation using the cam questionnaire can be performed by any member of the medical staff based on the instructions contained within the cam training manual .
the tool has already been translated into 10 languages and is being used in 10 non - english speaking countries .
it can be suspected that introducing the cam scale into everyday practice in poland will also facilitate the diagnostics of consciousness disorders ; however , one should keep in mind that evaluation using a questionnaire is only a screening tool , and one should always strive to confirm its preliminary diagnosis with a clinical examination , preferably conducted by a consulting psychiatrist . the questionnaire has been translated by physicians with active support provided by staff members of the aging brain center , the creators of the original version . the polish translation still requires validation on somatic wards as well as further studies to determine its effectiveness and sensitivity in clinical conditions .
the first obtained data indicate that the polish version of cam is characterized by good diagnostic accuracy , but its usefulness in everyday practice requires further studies with more precise validation of the questionnaire in clinical conditions .
 confusion on a somatic basis is a dangerous problem mainly related with aging of the population . 
 data says that consciousness disorders concern 10 - 15% of patients in general wards , and up to 50% of patients admitted to geriatric wards . 
 the persistence of the symptoms of confusion results in increase of agitation , disorganization , fear , which increases the risk of self - injuries of patients , it causes the need for parenteral feeding and hydratation , as well as maintaining water balance , and also disturbs cooperation , worsening the course and prognosis of the primary disease . 
 it is believed that consciousness disorders are one of the most difficult diagnostic problems and the most difficult therapy problem among psychotic disorders . 
 so far in poland there have been no screening evaluation tools to assess the occurrence of confusion on the somatic basis . 
 the purpose of this paper is to introduce the polish translation of the widely used scale to assess consciousness disorders , intended also for middle personnel of health care  confusion assessment method ( cam ) . 
 numerous studies over 16 years established the position of cam as an exceptionally effective standardized diagnostic test , specifying the sensitivity of 94 - 100% , specificity from 90 - 95% , positive predictive value of 91 - 94% , negative predictive value of 90 - 100% . the questionnaire and instructions of its interpretation have been translated by doctors with active help from the original creators of cam . 
 further studies are required in order to validate and determine the effectiveness of the newly formed diagnostic tool . 