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Disparities in Finding Delirium in Critically Ill Latinos.

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Delirium detection tools are inaccurate for Spanish-speaking ICU patients, missing 72% of cases. Caregiver-administered Family-CAM (FAM-CAM) significantly improved detection and may reduce language barriers in critical care.

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Area of Science:

  • Critical Care Medicine
  • Linguistic Health Disparities
  • Patient Safety

Background:

  • Delirium is a common and severe complication in Intensive Care Units (ICUs).
  • Patient-provider language discordance can hinder accurate delirium detection.
  • Existing delirium screening tools have not been adequately evaluated in linguistically diverse ICU populations.

Purpose of the Study:

  • To assess the accuracy of standard delirium screening practices in Spanish-speaking ICU patients.
  • To evaluate if caregiver-administered tools, like the Family-CAM (FAM-CAM), improve delirium detection across language barriers.
  • To examine language-based differences in delirium care, including sedation and restraint use.

Main Methods:

  • A prospective observational cohort study was conducted in two MICUs.
  • 142 ICU patients (English-speakers and Spanish-speakers) and 100 caregivers were enrolled.
  • Delirium detection was compared using Usual-Care (provider-administered CAM-ICU), Reference-standard (researcher-administered CAM-ICU), and FAM-CAM.

Main Results:

  • Delirium prevalence was 37% in English-speakers and 45% in Spanish-speakers.
  • Usual-Care had poor agreement with the Reference-standard in Spanish-speakers (κ=0.11), missing 72% of delirium cases.
  • FAM-CAM showed higher agreement (κ=0.68) and reduced missed delirium by 47% in Spanish-speakers.
  • Spanish-speakers experienced deeper sedation and higher rates of restraint use compared to English-speakers.

Conclusions:

  • Standard delirium detection methods are inaccurate for Spanish-speaking ICU patients.
  • The FAM-CAM tool demonstrates potential to improve delirium detection and mitigate language barriers.
  • Addressing language barriers is crucial for equitable delirium care and patient safety in the ICU.