Standard tools for diagnosing delirium in the intensive care unit are inaccurate in Spanish-speaking patients, researchers reported at the American Thoracic Society 2025 International Conference in San Francisco.
Dr. Ana Lucia Fuentes Baldarrago of the University of California, San Diego undertook the study when she found Spanish-speaking ICU patients who were classified as not delirious showed clear signs of delirium when engaged in Spanish.
She had also encountered patients labeled as delirious who were simply unable to communicate effectively because they did not speak English.
In 63 ICU patients – 29 Spanish-speakers and 34 English-speakers – her team compared three delirium assessment tools.
Two are administered by providers: the English-language Confusion Assessment Method (CAM) for the ICU, and a Spanish-language version of the same tool.
The third tool was a new version of the Spanish-language tool designed by the researchers for family caregivers to complete. While the Spanish CAM is the gold-standard assessment for Spanish-speaking patients when administered by a Spanish-speaking provider, there are not enough bilingual providers available to administer it in the United States.
Traditional screening methods were not accurate in Spanish-speaking ICU patients when the patient and provider did not speak the same language, the researchers found.
Their new Spanish assessment for families to complete was comparable to gold-standard assessments and outperformed usual screening practices in detecting delirium.
"These findings underscore the urgent need to evaluate commonly used clinical tools in diverse populations, particularly among non-English-speaking patients who are frequently excluded from clinical trials," Fuentes Baldarrago said
Spanish-speaking patients also had significantly higher odds of being subjected to physical restraints and deep sedation, and lower odds of receiving evidence-based, delirium-prevention interventions such as physical and occupational therapy, Fuentes Baldarrago said.
Her team hopes to conduct larger studies of their tool for families to evaluate whether its use can reduce misclassification and improve clinical outcomes.
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