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Introduction: The influence of patients’ language preference on the delivery of acute ischemic stroke (AIS) care in the pre-hospital and in-hospital emergency care settings is scarcely known. We hypothesize that stroke knowledge differences may be associated with non-English preferring (NEP) patients having slower time from symptom discovery to hospital presentation and less engagement of emergency medical services (EMS) than English preferring (EP) patients. Language barriers may also interfere with the delivery of time-sensitive emergency department care.Objectives: To identify whether language preference is associated with differences in patients’ time from stroke symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DIT), and door-to-needle (DTN) time.Methods: We identified consecutive AIS patients presenting to a single urban, tertiary, academic center between 01/2003-04/2014. Data was abstracted from the institution’s Research Patient Data Registry and Get with the Guidelines-Stroke Registry. Bivariate and regression models evaluated the relationship between language preference and: 1) time from symptom onset to hospital arrival, 2) use of EMS, 3) DIT, and 4) DTN time.Results: Of 3,190 AIS patients who met inclusion/exclusion criteria, 9.4% were NEP (n=300). Time from symptom discovery to arrival, and EMS utilization were not significantly different between NEP and EP patients in unadjusted or adjusted analyses (overall median time 157 minutes, IQR 55-420; EMS utilization: 65% vs. 61.3% p=0.21). There was no significant difference between NEP and EP patients in DIT or in likelihood of DIT ≤ 25 minutes in unadjusted or adjusted analyses (overall median 59 minutes, IQR 29-127; DIT ≤ 25 minutes 24.3% vs. 21.3% p=0.29). There was also no significant different in DTN time or in likelihood of DTN ≤ 60 minutes in unadjusted or adjusted analyses (overall median 53 minutes, IQR 36-73; DTN ≤ 60 minutes 62.5% vs. 58.2% p=0.60).Conclusion: Non-English-preferring patients have similar response to stroke symptoms as reflected by EMS utilization and time from symptom discovery to hospital arrival. Similarly, NEP patients have no differences in in-hospital AIS care metrics of DIT and DTN time.