Language barriers between ICU providers and Spanish-speaking patients led to inaccurate delirium screening results using standard tools.
RT’s Three Key Takeaways:
- Standard delirium tools may misclassify Spanish-speaking patients: Language barriers between ICU providers and Spanish-speaking patients led to inaccurate delirium screening results using standard tools like CAM-ICU—resulting in both false positives and missed diagnoses.
- Family-informed Spanish screening tool performs better: The new Spanish-FAM tool, which engages family caregivers, detected delirium more accurately and matched performance of the gold-standard bilingual CAM-ICU—outperforming conventional screening by providers who don’t speak Spanish.
- Misclassification linked to harmful disparities: Spanish-speaking patients were more likely to be restrained or deeply sedated and less likely to receive preventive care, increasing their risk of delirium. The findings highlight the urgent need for culturally and linguistically adapted screening tools in the ICU.
Standard ICU delirium screening tests may result in the misclassification of the delirium status of Spanish-speaking patients, according to data presented at ATS 2025. The research also shows that a Spanish-language screening tool that involves family caregivers outperforms conventional screening practices.
The study highlights an important disparity in care, revealing that a false positive delirium diagnosis may result in increased use of physical restraints, while a missed diagnosis can result in patients receiving deeper sedation and not receiving standard delirium-prevention care, researchers said. Ironically, these factors can ultimately increase risk of patients developing delirium while in the ICU.
“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,” said Ana Lucia Fuentes Baldarrago, MD, a researcher at the University of California, San Diego. They also highlight the need for more objective measures of delirium, she added.
The study was inspired, in part, by clinical experiences with Spanish-speaking patients who had been misdiagnosed, said Dr. Fuentes Baldarrago, who is bilingual. In some cases, patients were classified as not delirious, but showed clear signs of delirium when engaged in Spanish. Conversely, she also encountered patients labeled as delirious who were simply unable to communicate effectively because they were unable to communicate with providers in their own language, she said.
Current guidelines recommend regular delirium screening in the ICU with tools including the Confusion Assessment Method for the ICU (CAM-ICU), which is administered by providers. Other tools include the Family Confusion Assessment Method (FAM-CAM), which engages family caregivers to help identify signs of delirium in their loved ones.
For the study, researchers developed Spanish-FAM, a translation and cross-cultural adaptation of FAM-CAM. They then compared two assessment methods: CAM-ICU completed as per usual care practice by bedside providers and Spanish-FAM completed by family caregivers. These assessments were then compared against a gold-standard selected by the research team: the previously validated and translated Spanish-language CAM-ICU, administered by a trained bilingual member of the research team. While the Spanish-language CAM-ICU offers an ideal solution to overcome language barriers between patients and providers, researchers note that there are simply not enough bilingual providers available to widely implement this translated tool across the United States.
They found that traditional screening methods were not accurate in Spanish-speaking ICU patients when the patient and provider didn’t speak the same language. Meanwhile, Spanish-FAM was comparable to gold-standard assessments and outperformed usual delirium screening practices in detecting delirium.
Spanish-speaking patients also had significantly higher odds of being subjected to physical restraints and deep sedation compared to English-speaking patients- which are factors known to increase the risk of ICU delirium. Additionally, Spanish-speaking patients had lower odds of receiving evidence-based, delirium-prevention interventions such as physical and occupational therapy which are strategies known to reduce the risk of delirium, Dr. Fuentes Baldarrago said.
“These findings suggest that Spanish-speaking patients who experience patient-provider language discordance may be at high risk for developing ICU delirium,” she said.
To follow up, researchers plan to explore the use of serum biomarkers for delirium detection, and conduct larger studies involving Spanish-FAM to evaluate whether its use can reduce misclassification and improve clinical outcomes.
