COMMONLY used ICU delirium screening tools often misclassify Spanish-speaking patients according to new research presented at 2025 American Thoracic Society International (ATS) Conference in San Francisco. This misdiagnosis may lead to inappropriate treatment strategies, including excessive sedation or unnecessary physical restraints—factors known to increase delirium risk.
Delirium screening is a standard recommendation in intensive care units across the United States. However, the study led by Ana Lucia Fuentes Baldarrago, of the University of California San Diego, shows that current tools like the Confusion Assessment Method for the ICU (CAM-ICU), when used without language-concordant providers, are unreliable in Spanish-speaking populations.
The research introduced the Spanish-FAM, a caregiver-administered, translated version of the Family Confusion Assessment Method. The Spanish-FAM was tested against both traditional CAM-ICU screenings and a gold-standard evaluation—the Spanish-language CAM-ICU performed by trained bilingual staff.
Findings showed that language discordance between patient and provider led to misdiagnoses, either falsely identifying delirium or overlooking it. Spanish-FAM, however, performed comparably to the gold standard and outperformed usual care practices in detecting delirium accurately.
Crucially, Spanish-speaking patients had higher odds of experiencing deep sedation and physical restraint, while being less likely to receive evidence-based interventions such as physical and occupational therapy, known protective strategies against delirium. These disparities are directly linked to inaccurate delirium classification due to language barriers, the researchers said.
“This study highlights the urgent need to assess clinical tools for cultural and linguistic appropriateness,” said Fuentes Baldarrago. “Non-English-speaking patients are often excluded from trials, and that exclusion has real-world implications.”
Future research will examine biomarkers for delirium and assess the long-term impact of Spanish-FAM use on clinical outcomes.
Reference:
Fuentes Baldarrago AL et al. ICU Delirium Tests Misclassify Spanish-Speakers. ATS 2025 International Conference. Available at: https://site.thoracic.org/press-releases/icu-delirium-tests-misclassify-spanish-speakers. Last accessed: May 20, 2025.
