Language preference does not influence stroke patients' symptom recognition or emergency care time metrics

Abstract

Our objective was to determine whether acute ischemic stroke (AIS) patients' language preference is associated with differences in time from symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DTI), and door-to-needle (DTN) time. We identified consecutive AIS patients presenting to a single urban, tertiary, academic center between 01/2003-05/2014 for whom language preference was available. Data were abstracted from the institution's Research Patient Data Registry and Get with the Guidelines-Stroke Registry. Bivariate and regression models evaluated the relationship between language preference and: 1) time from symptom onset to hospital arrival, 2) use of EMS, 3) DTI, and 4) DTN time. Of 3190 AIS patients, 300 (9.4%) were non-English preferring (NEP). Comparing NEP to English preferring (EP) patients in unadjusted or adjusted analyses, time from symptom discovery to arrival and rate of EMS utilization were not significantly different (overall median time 157min, IQR 55-420; EMS utilization: 65% vs. 61.3% p=0.21). There was also no significant differences in DTI or in likelihood of guideline-recommended DTI≤25min (overall median 59min, IQR 29-127; DTI≤25min 24.3% vs. 21.3% p=0.29) or DTN time or in likelihood of guideline-recommended DTN≤60min (overall median 53min, IQR 36-73; DTN≤60min 62.5% vs. 58.2% p=0.60). Consistent with prior reports examining disparities in care, a systems-based approach to acute stroke prevents differences in hospital-based metrics. Reassuringly, NEP and EP patients also had similar speed of symptom recognition and EMS utilization.