Abstract TP301: Primary Language Predicts Outcomes in Acute Ischemic Stroke

Abstract

Introduction: Intravenous (IV) thrombolysis with tissue plasminogen activator (tPA) is the only FDA approved medical therapy for acute ischemic stroke. There is a paucity of data regarding the effect of primary language on outcomes in stroke patients. The aim of this study was to determine if primary language impacts outcomes of acute stroke patients receiving IV thrombolysis. Methods: This is a retrospective study of patients with acute ischemic stroke who received IV tPA at our institution from January 1, 2013 to December 31, 2016. Subjects were divided by primary language based on structured chart review. Subgroups for Non-English speakers were Spanish, Vietnamese, and Other language. Outcomes were modified Rankin scale (mRS) at discharge, favorable outcome (mRS score 0-2) at discharge, mortality at hospital discharge, and length of stay (LOS). Statistical analysis of data was done with unpaired t test and ANOVA multi-variant analysis as appropriate. Results: During the study period, 190 patients received IV tPA for acute stroke. Among them, 120 primarily spoke English, 35 Spanish, 22 Vietnamese, and 13 Other languages. Favorable outcome at discharge was highest in Vietnamese group at 50%, followed by English (48%), Spanish (40%), and Other language group (7.7%). English and Vietnamese groups scored nearly two points better on average mRS at discharge than the Other language group. The mortality rate was highest in the Other language group at 15.4%, followed by English (9.2%), Vietnamese (4.5%), and then Spanish group (2.9%). English speaking patients had shorter mean LOS (4.2 days versus 5.2 days; 95% CI 0.068-2.02) compared to Non-English speaking patients. Average LOS for the Other language group was one week longer than other groups. The Other language group was also least likely to be discharged home (7.7%) compared to English (34.5%), Spanish (42.9%) and Vietnamese (50.0%) groups. Conclusions: This study demonstrated an outcome advantage for tPA patients whose primary language is more frequent (English, Spanish, and Vietnamese) at a multi-ethnic regional hospital. Patients whose primary language was uncommon (Other language) had higher mortality rate, longer LOS, and were less likely to be discharged home than frequent language groups.