Disparities in Finding Delirium in Critically Ill Latinos

OBJECTIVES: 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. DESIGN: Prospective observational cohort study. SETTING: Two MICUs at the University of California, San Diego. PATIENTS: 142 ICU patients and 100 caregivers were enrolled between August 2024 and January 2025. INTERVENTIONS: 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). MEASUREMENTS AND MAIN RESULTS: 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. CONCLUSIONS: 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.