The Impact of Language Barriers on Acute Stroke Treatments
Samantha Cheng1, Sarah Wang1, Gautham Upadrasta1, Austin Saline2, Liane Hunter3, Michelle Ganat2, Stella Iskandarian2, Esther Levison1, Daniel Labovitz1, Oleg Otlivanchik2, Charles Esenwa2, Lauren Gluck2
1Montefiore Medical Center/Albert Einstein College of Medicine, 2Montefiore Medical Center, 3Brigham and Women's Hospital
Objective:

To determine if non-English speaking patients experience delays in acute stroke intervention compared to English-speaking patients.

Background:

Disease-modifying treatment for stroke depends on rapid evaluation. Communication across language barriers may delay or impair obtaining accurate history, performing elements of the neurological exam, screening for contraindications, and assenting/consenting to treatment.

Design/Methods:

This is a retrospective study utilizing 305 patients who underwent acute stroke intervention (thrombolysis with alteplase or tenecteplase and/or mechanical thrombectomy) at two urban comprehensive stroke centers 2021-2023. We categorized each patient’s primary speaking language as English, Spanish, or Other. Linear regressions were performed to analyze the entire data set and treatment type subgroups. To account for other causes of treatment delay, we also included the following covariates: low National Institutes of Health Stroke Scale (NIHSS) (NIHSS<4), presence of peri-code medical events (intubation, nausea/vomiting, seizure, agitation), signs of hemodynamic instability, and medical comorbidities and demographic features

Results:

Median door-to-needle (DTN) time was 48 minutes. Median door-to-thrombectomy (DTT) time was 142 minutes. Language was associated with delayed DTT in the subset of patients who received both thrombolysis and thrombectomy (p=0.0147). Peri-code nausea/vomiting (p=0.0285), elevated blood pressure (p=0.0419), low NIHSS (p=0.0320), and history of atrial fibrillation (p=0.0331) were associated with longer DTN times in patients who underwent thrombolysis. In the subgroup of patients who underwent thrombolysis without thrombectomy, only a history of atrial fibrillation was associated with increased DTN time (p=0.0212).  Low NIHSS was associated with longer DTT times in all patients who underwent thrombectomy (p<0.001) and the subset of patients who underwent thrombectomy without thrombolysis (p<0.001).

Conclusions:
Our study confirmed several factors known to delay acute stroke intervention, including language. We hypothesize that the impact of language on patients who receive both thrombolysis and thrombectomy is related to the increased communication needed to screen and consent for treatments.
10.1212/WNL.0000000000208910
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