Abstract WP387: Language Barrier Impacts Outcome From Acute Ischemic Stroke Without Effect on Receiving Intravenous Thrombolysis

Abstract

Objectives: Early treatment is crucial for patients with acute ischemic stroke (AIS). Language barrier may delay evaluation and therapy. This study aimed to evaluate the impact of primary language on outcome in patients with AIS. Methods: This is a retrospective study of consecutive patients with AIS at our institution from January 1, 2013 to December 31, 2016. Data were collected from the electronic medical record and the Get With the Guidelines database. Patients were divided into three groups by primary language. Outcome measures include rate of intravenous thrombolysis (IVT), length of stay (LOS), functional outcome per modified Rankin scale (mRS), and mortality at hospital discharge. Statistical analysis was done by non-parametric testing with Kruskal-Wallis for multiple comparisons between groups and Chi-square analysis for comparison of proportions. Results: Among the 1,117 patients included within the study period, 189 received IVT. In this cohort, 759 patients spoke English, 194 spoke Spanish, and 164 spoke Other languages including Vietnamese, Arabic, and Mandarin. The severity of stroke per mean NIHSS on arrival was highest at 12 (95% CI, 10-13) in Other-language group, 9.1 (95% CI, 8.5-9.7, P <0.001) in English group and 8.6 (95% CI, 7.5-9.7, P =0.002) in Spanish group. There was no significant difference in the rate of receiving IVT among the 3 groups, with 16% in English and Spanish groups and 19.5% in Other-language group ( P =0.62). The Other language group has significantly longer LOS (6.7, 95% CI 5.6-7.8) than the Spanish (6.0, 95% CI 5.0-6.9) and English (5.2, 95% CI, 4.8-5.6, P <0.001) groups and worse outcomes with mean mRS 3.5 (95% CI, 3.2-3.7) at hospital discharge compared to English (2.9, 95% CI, 2.8-3.1, P =0.008) and Spanish (2.9, 95% CI, 2.7-3.2, P =0.02) groups, and lower rate of favorable outcome with mRS 0-2 (26.8%) compared to English (41.5%) and Spanish groups (38.7%) ( P =0.0022). Mortality was not significantly different between English (7.9%), Spanish (3.2%), and Other groups (7.9%, P =0.06). Conclusions: At our multiethnic cohort, primary language has no effect on acute stroke therapy with IVT. However, the non-English and non-Spanish speaking patients tended to have longer LOS and worse functional outcome.