Addressing Language Barriers to ICU Delirium Detection

<h3>Background</h3> Delirium is a common and serious condition in the ICU associated with adverse outcomes. However, delirium can be challenging to detect, especially among patients with limited English language proficiency. Given the rise in the Spanish-speaking Hispanic and Latino population in the United States, we sought to translate into Spanish and culturally adapt for Hispanic and Latino adults an alternative delirium screening tool, the Family-Confusion Assessment Method for the ICU (Family-CAM). <h3>Research Question</h3> Our objective was to translate and culturally adapt the Family-CAM into Spanish (the Spanish-Language Family-Confusion Assessment Method for the ICU [Spanish-FAM]) and to evaluate its performance among Spanish-speaking patients in the ICU. <h3>Study Design and Methods</h3> The translation and cross-cultural adaptation process included double-forward and back translations and harmonization by a team of bilingual physicians representing multiple Spanish-speaking global regions. We then identified 20 Spanish-speaking patients in the ICU and their family caregivers (dyads) on admission. A trained bilingual assessor administered the validated Spanish-language Confusion Assessment Method for the ICU (Spanish-CAM), which served as the gold standard for delirium assessments. The performances of the Spanish-FAM (performed by family caregivers) and usual care (the Confusion Assessment Method for the ICU documented by bedside providers) then were compared with those of the Spanish-CAM using Cohen's κ to assess for agreement between assessments. <h3>Results</h3> The Spanish-FAM maintained conceptual equivalence to the original English version. The Spanish-FAM demonstrated substantial agreement with the gold standard Spanish-CAM (κ = 0.68), with high sensitivity (91%) and specificity (85%). In contrast, usual care showed minimal agreement with the gold standard Spanish-CAM (κ = 0.16), with a sensitivity of only 18%. <h3>Interpretation</h3> These findings suggest that usual care may be unreliable in Spanish-speaking patients in the ICU, whereas the Spanish-FAM may be a strong alternative tool for more accurate delirium assessments in this population.