Abstract
Introduction: Previous reports raised concerns that time dependent treatments in acute ischemic stroke (AIS) might be delayed on non-English speaking patients. Here we report an analysis of patients after AIS stratified by primary language who were admitted to two large comprehensive stroke centers in California. The purpose of this analysis was to examine the impact of primary language on treatment times, frequency and causes of not using thrombolysis. Methods: We included all patients admitted between 12/2019-4/2022 who presented to a Comprehensive Stroke Center (CSC) using the electronic medical record (EMR). Language preference was identified as English (ES) or Non-English (NES). We compared comorbidities, demographics, baseline NIHSS, stroke time metrics [stroke onset to arrival (LTD), arrival to CT (DTC), arrival to tPA (DTN)], frequency of tPA administration and exclusion for last known normal (LKN) > 4.5 hours between ES and NES. We utilized Chi-squared, t-test, ANOVA as appropriate and a p value of <0.05 was significant. Results: We identified 1815 patients, ES n=1489, NES n=326. There was no significant difference in the mean age between groups (ES 67±16; NES 66±16, p=0.93). There was no significant difference in mean LTD between groups (NES 99.3±58.9 minutes (min); ES 83.6±52 min). There was no significant difference in mean DTC between groups (NES 13.2±8.5 min; ES 12±10.2 min). There was no significant difference in mean DTN between groups (NES 54.4±23.3 min; ES 53.8±27.9 min). There was a significant difference in ambulance arrival (p=0.001), HTN (p=0.01), DM (p=0.001), drug/alcohol use (p=.001), and smoking (p=.001). There was no significant difference in LKW to door (p=.12), DTC (p=.44), DTN (p=0.88). Conclusion: Primary language did not affect acute stroke time metrics at this academic CSC. This is likely due to the 24/7 availability of interpreter services at this CSC. Further studies must assess the impact of language preference on stroke time metrics and outcome in a heterogenous sample of healthcare settings. Communicating in patients’ preferred language is vital to rapid care and patient engagement in the acute stroke setting.
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