Abstract 17: The Use of Thrombolysis among Acute Ischemic Stroke Patients with Limited English Proficiency

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Abstract

Background: Over 17.2% of the U.S. population primarily speaks a language other than English at home. Limited-English proficiency (LEP) may negatively impact patients, yet its influence on stroke patients’ receipt of thrombolysis remains unknown.

Objectives: To evaluate the influence of LEP on acute ischemic stroke patients’ receipt of thrombolysis.

Methods: We analyzed data from 3,894 acute ischemic stroke patients who participated in “Get With The Guidelines - Stroke” at Massachusetts General Hospital 1/1/2003-4/30/2014. Information included patients’ language in which they preferred to receive medical care; those who identified a language other than English were considered to have LEP. We performed descriptive statistics and stepwise logistic regression models to examine associations between patients’ LEP status and the use of IV tPA, adjusting for relevant covariates.

Results: A total of 307/3894 (9.3%) acute ischemic stroke patients met LEP criteria, representing 25 different languages [Table 1]. Multivariable analyses showed that patients with LEP were more likely than English-speaking patients to receive IV tPA when adjusting for socioeconomic factors (OR=1.64, CI=1.09-2.48, p=0.02). Models that also incorporated patients’ age, sex, and initial NIHSS did not find a statistically-significant effect for LEP on patients’ receipt of IV tPA but highlighted that patients’ NIHSS seemed to be the driving force of IV tPA receipt (OR=1.15; CI=1.13-1.16; p<0.001) [Table 2].

Conclusion: Contrary to our hypothesis, acute ischemic stroke patients with LEP were more likely to receive IV tPA than English-speaking patients; this seemed to be driven by their worse stroke severity.

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