Disparities in Finding Delirium in Critically Ill Latinos.

Abstract

Delirium is common in the ICU and is associated with devastating consequences. However, the accuracy of delirium detection tools has not been evaluated when patient-provider language discordance is present. This study aimed to assess the accuracy of delirium screening practices in Spanish-speaking ICU patients, evaluate whether caregiver-administered tools improve detection amid language barriers, and examine language-based differences in delirium care. Prospective observational cohort study. Two MICUs at the University of California, San Diego. 142 ICU patients and 100 caregivers were enrolled between August 2024 and January 2025. Usual-Care (Confusion Assessment Method [CAM]-ICU completed by bedside providers), Reference-standard (English or Spanish-language CAM-ICU performed by research staff), and FAM-CAM (English or Spanish-language Family-CAM administered by caregivers). Among 71 English-speakers, 34 female (47%), with a mean (sd) age of 62 years (16). Among 71 Spanish-speakers, 26 female (37%) and the mean age was 60 years (15). The prevalence of delirium was 39% overall, affecting 26 (37%) English-speakers and 32 (45%) Spanish-speakers. Agreement between Usual-Care and Reference-standard was higher in English-speakers than in Spanish-speakers (κ=0.71 vs. κ=0.11; z=-4.98, p < 0.01), with 72% of delirium missed in Spanish-speakers. Among Spanish-speakers, FAM-CAM showed higher agreement with Reference-standard than did Usual-Care (κ=0.68 vs. κ=0.11; z= -4.69, p < 0.05) and reduced the rate of missed delirium by 47%. Spanish-speakers were more deeply sedated (mean Richmond Agitation Sedation Scale -1.46 [sd 1.38] vs. -0.77 [sd 1.31]; mean difference 0.69; 95% CI, 0.24 to 1.14, p < 0.01) and had higher odds of restraint use (odds ratio 4.53; 95% CI 1.91 to 10.74; p < 0.01) than English-speakers. Usual-Care demonstrated poor accuracy in delirium detection among Spanish-speakers, who also experienced deeper sedation and more frequent restraint use than English-speakers. FAM-CAM improved delirium detection among Spanish-speakers and may help overcome language barriers to equitable delirium detection.