Objective:

We aim to investigate whether interpreter language or modality impacts door-to-needle (DTN) times in acute Telestroke assessments. 

Background:

Rapid administration of intravenous thrombolysis is critical in acute ischemic stroke, as shorter DTN times improve outcomes. Telestroke programs have expanded access and reduced disparities, yet the influence of interpreter services (IS) and translation modality (TM) on treatment timeliness is poorly characterized. This parent study revealed a 4.5-minute increase in DTN when IS are utilized. 

Design/Methods:

We conducted a planned subgroup analysis of acute stroke consultations requiring IS performed by TeleSpecialists, LLC neurologists from January–December 2021. Encounters were extracted from the Telecare by TeleSpecialists™ database. TM (bedside, audio/visual, or family/non-certified) and patient language were categorized. DTN times were compared using the Wilcoxon test, with median values, interquartile ranges (IQR), and p-values reported.

Results:

A total of 2,795 patients were included. The most frequent languages were Spanish (69.7%), Vietnamese (4.6%), and Chinese (1.9%). Median DTN times varied by language, ranging from 21 minutes (IQR 20–30) for Chinese to 77 minutes (IQR 48–106) for Portuguese. Only Chinese demonstrated a statistically significant difference compared with other languages (p=0.036). Bedside interpretation (41%) yielded the shortest median DTN (39 min [IQR 29–59], p=0.059). Audio/visual (37%), family (16%), and non-certified (6%) modalities were associated with longer DTN times, though differences were not statistically significant. Family members used as second-line interpreters had slower DTN (52 min [IQR 42–72], p=0.24) compared to first-line use (49 min [IQR 38–57], p=0.51).

Conclusions:

Interpreter modality may meaningfully influence DTN times in acute ischemic stroke, while patient language itself appears less impactful. These findings highlight interpreter workflow and technology integration as modifiable system factors in Telestroke networks. Further investigation into standardized, rapid-access interpreter protocols may improve treatment efficiency and equity across linguistically diverse populations.