Research Reveals Bias in ICU Delirium Screening for Spanish-Speaking Patients

Delirium frequently occurs in intensive care units (ICUs), and routine screening is recommended daily to identify and manage this condition promptly. However, recent research presented at the ATS 2025 International Conference indicates that conventional delirium assessment tools may not be as effective for Spanish-speaking patients, often leading to inaccurate classifications.

The study highlights a significant disparity in care: misdiagnoses can result in either unnecessary physical restraints due to false positives or inadequate treatment stemming from missed diagnoses. Such inaccuracies can paradoxically elevate the risk of developing ICU delirium. Dr. Ana Lucia Fuentes Baldarrago from the University of California, San Diego, emphasized the importance of evaluating clinical tools across diverse populations, particularly among non-English speakers who are frequently underrepresented in clinical research.

The motivation for this study stemmed from clinical observations where Spanish-speaking patients were misclassified. Some patients who showed clear signs of delirium when engaged in Spanish were not identified as delirious by existing assessments, while others labeled as delirious could not communicate effectively due to language barriers.

Current screening methods, like the Confusion Assessment Method for the ICU (CAM-ICU) and the Family Confusion Assessment Method (FAM-CAM), rely heavily on provider assessments and patient communication, which can falter in language discordant situations.

To address this, researchers developed the Spanish-FAM, a culturally adapted translation of FAM-CAM, and compared it to standard assessments. The study involved traditional CAM-ICU assessments by bedside providers, family caregiver evaluations using Spanish-FAM, and a gold-standard Spanish CAM-ICU administered by a bilingual research team member. Findings revealed that while Spanish-FAM was comparable to the gold standard and outperformed usual screening practices among Spanish speakers, the standard tools were often inaccurate in language-discordant scenarios.

Furthermore, Spanish-speaking ICU patients faced higher odds of being subjected to restrictive measures and deep sedation—factors that increase delirium risk—along with receiving fewer evidence-based prevention strategies like physical and occupational therapy.

These insights suggest that language barriers significantly contribute to misclassification and suboptimal care. The researchers advocate for wider use of validated, culturally sensitive assessment tools like Spanish-FAM and exploring additional biomarkers to improve delirium detection and patient outcomes across diverse populations.

Future investigations aim to evaluate whether implementing such tools can reduce misdiagnosis and improve clinical results for Spanish-speaking patients in ICUs.

source: https://medicalxpress.com/news/2025-05-icu-delirium-misclassify-spanish-speakers.html