Subscale 1 Recognition-information processing (14 points) | |
▪ Attention: Attention-Alertness-Responsiveness (0–4 points) ▪ Command: Recognition-Interpretation-Action (0–5 points) ▪ Orientation: Orientation-Short-term memory-Thought/Speech content (0–5 points) | |
Subscale 2 Behavior (10 points) | |
▪ Appearance (0–2 points) ▪ Motor (0–4 points) ▪ Verbal (0–4 points) | |
Subscale 3 Physiologic control (6 points) | |
▪ Vital function stability (0–2 points) ▪ Oxygen saturation stability (0–2 points) ▪ Urinary continence control (0–2 points) | |
Total score (0–30 points) | |
▪ 0–19 points: Moderate to severe confusion ▪ 20–24 points: Mild or early development of confusion ▪ 25–26 points: “Not Confused,” but at high risk of confusion ▪ 27–30 points: “Not Confused,” or normal function |