Abstract W P268: Language Discordance Between Patient and Treating Physician Does Not Delay Time to Thrombolysis
Introduction: Shorter door-to-needle time (DNT) is associated with better outcomes in acute ischemic stroke. Reducing door-to-CT time is a major focus of national quality improvement initiatives designed to reduce DNT, however time from CT-to-tPA administration has received far less attention. Recent data suggests that the CT-to-tPA interval contributes to significant delays in DNT. We hypothesized that language barriers between patients and treating neurologists would lead to longer CT-to-tPA times at a single stroke center serving a large Spanish-speaking population.
Methods: We retrospectively reviewed the electronic medical record (EMR) on all patients who received IV-tPA in the emergency department over 2.5 years (July 2011 to December 2013). Patient’s primary language was obtained from the EMR; language fluency of treating neurologists was self-reported via standardized questionnaire. We compared baseline characteristics and relevant time intervals between encounters where the treating neurologist and patient spoke the same language (concordant group) versus those where they spoke a different language (discordant group). Means were compared with t-tests, medians with Mann-Whitney U tests, and dichotomized variables with Fisher exact tests.
Results: A total of 199 patients received IV-tPA during the study period. English was the primary language for 110, Spanish for 83, and other languages for 6; of these, 120 cases were classified as concordant and 79 as discordant. There were no significant differences in mean age (67 vs. 69, p=0.3), male sex (37.5% vs. 24.1%, p=0.06), and median NIHSS (7 vs. 6, p=0.9) between concordant and discordant groups. We found no differences between median onset-to-arrival (68 vs. 71, p=0.3), door-to-CT (25 vs. 25, p=0.8), CT-to-tPA (33 vs. 29, p=0.2) and DNT (61 vs. 60, p=0.3) in minutes. There was a trend towards a greater proportion of patients with CT-to-tPA time under 30 minutes in the discordant group (52% vs. 38%, p=0.08).
Conclusion: At our institution, language discordancy did not contribute to delays in CT-to-tPA nor overall DNT. CT-to-tPA time represents a largely unexplored contributor to overall delays in DNT that warrants further investigation.
Author Disclosures: S.K. Rostanski: None. O. Williams: None. R.S. Marshall: None. J. Stillman: None. J.Z. Willey: None.
- © 2015 by American Heart Association, Inc.