Effect of primary patient language on large-vessel occlusive stroke treatment and functional outcomes.

BACKGROUND AND PURPOSE

Patients with limited English proficiency may face barriers to acute ischemic stroke (AIS) care. This study investigates whether medical interpreter requirement for AIS patients affects access to endovascular therapy (EVT) or outcomes.

METHODS

Retrospective review of an AIS database at a single comprehensive stroke center from 1/2021-12/2021 was conducted. Patient demographics, baseline and post-treatment AIS parameters were recorded. Patients were grouped by interpreter requirement. A propensity-matched cohort for interpreter requirement was created matching for age, presenting National Institute of Health Stroke Scale (NIHSS), occlusion site and side, thrombolytic treatment, and EVT. Primary outcomes included discharge NIHSS and modified Rankin score (mRS), and 90-day mRS. Secondary outcomes included NIHSS shift from presentation to discharge.

RESULTS

Among 355 included patients, 321 (90.4 %) spoke English. English speakers were more likely to identify as white (85.6 % vs 38.2 %, p < 0.001). Non-English speakers presented with higher NIHSS (median 21 [IQR 15-24] vs. 14 [6-20], p < 0.001). Rates of thrombolytic administration (41.7 % vs 20.9 %) or EVT (61.8 % vs. 66.0 %) were similar between groups. Among thrombectomy patients, the times from hospital arrival to device deployment or recanalization were not significantly different by language group. Discharge mRS (5 [4-5] vs. 4 [3-5], p = 0.023) and NIHSS (9 [1-19] vs. 3 [1-12], p = 0.026) were higher for non-English speakers. There was no significant difference in NIHSS shift or the rate of 90-day mRS 0-2 (23.5 % vs 34.3 %). The propensity-matched cohort included 30 patients in each group and demonstrated higher premorbid and discharge mRS, and admission and discharge NIHSS for non-English speakers (p < 0.019).

CONCLUSIONS

Non-English speaking AIS patients present with more severe symptoms and are discharged with poorer reported neurological function despite receiving similar treatments to English speakers. Patients with limited English proficiency may face barriers to acute ischemic stroke (AIS) care. This study investigates whether medical interpreter requirement for AIS patients affects access to endovascular therapy (EVT) or outcomes. Retrospective review of an AIS database at a single comprehensive stroke center from 1/2021-12/2021 was conducted. Patients were grouped by interpreter requirement. A propensity-matched cohort for interpreter requirement was created matching for age, presenting National Institute of Health Stroke Scale (NIHSS), occlusion site and side, thrombolytic treatment, and EVT. Primary outcomes included discharge NIHSS and modified Rankin score (mRS), and 90-day mRS. Secondary outcomes included NIHSS shift from presentation to discharge. Among 355 included patients, 321 (90.4 %) spoke English. English speakers were more likely to identify as white (85.6 % vs 38.2 %, p < 0.001). Non-English speakers presented with higher NIHSS (median 21 [IQR 15-24] vs. 14 [6-20], p < 0.001). Rates of thrombolytic administration (41.7 % vs 20.9 %) or EVT (61.8 % vs. 66.0 %) were similar between groups. Discharge mRS (5 [4-5] vs. 4 [3-5], p = 0.023) and NIHSS (9 [1-19] vs. 3 [1-12], p = 0.026) were higher for non-English speakers. There was no significant difference in NIHSS shift or the rate of 90-day mRS 0-2 (23.5 % vs 34.3 %). The propensity-matched cohort included 30 patients in each group and demonstrated higher premorbid and discharge mRS, and admission and discharge NIHSS for non-English speakers (p < 0.019). Non-English speaking AIS patients present with more severe symptoms and are discharged with poorer reported neurological function despite receiving similar treatments to English speakers.