Abstract P127: Non-English Speakers and English Speakers Score Differently on Individual Components of the National Institutes of Health Stroke Scale

Abstract

Introduction: The National Institutes of Health Stroke Scale (NIHSS) is widely used for rapid assessment of neurologic deficits in acute stroke. Multiple components of the scale require intact language function, which may be difficult for English-speaking providers to assess in non-English speaking patients (NESP). We sought to characterize patterns of NIHSS scoring in English-speaking patients (ESP) and NESP. Methods: This was a retrospective study of consecutive stroke alert cases who presented to the emergency department at our primarily English-speaking comprehensive stroke center. Baseline characteristics and clinical data including NIHSS components were compared between ESP and NESP. Chi-squared/Fisher’s exact statistics were used to compare frequencies and T-tests were used to compare means. Relative risks were calculated for language effects on NIHSS components, controlling for gender, age, race, and stroke diagnosis. Results: A total of 1166 patients were included, of which 87.5% were ESP and 12.5% were NESP. There were no significant differences between groups in total NIHSS scores or in frequencies of stroke diagnosis, tissue plasminogen activator treatment, or endovascular treatment. For individual NIHSS components, NESP were more likely than ESP to score for level of consciousness questions (34.9% vs 22.3%, adjusted RR 1.91, CL 1.39-2.62, p=0.0005), level of consciousness commands (21.9% vs 10.1%, adjusted RR 3.62, CL 2.42-5.43, p<0.0001), and best language (30.1% vs 22.6%, adjusted RR 1.84, CL 1.32-2.56, p=0.0016). Other NIHSS components did not differ significantly between groups after covariate adjustments. Conclusions: Despite similarities in total NIHSS scoring between NESP and ESP, scoring of individual components heavily dependent on language function and comprehension differed between groups. NESP were more likely to be assessed as aphasic, unable to answer questions, and unable to follow commands. Disparities in NIHSS scoring trends raise questions for further investigation into possible underlying pathophysiologic mechanisms, potential provider biases from language barriers that may influence clinical assessment, and the role of more inclusive screening tools and interventions to help mitigate these gaps.