Introduction: The earlier acute stroke patients receive intravenous (IV) tissue plasminogen activator (tPA), the better the chance of recovery. Nearly half the patients at our medical center speak Spanish, Vietnamese, or other languages. Language may be a barrier to timely acute stroke therapy.
Objective: To determine if primary language influences evaluation and door-to-needle time for IV tPA.
Methods: This is a single center retrospective study of all acute stroke patients who received IV tPA at our center from January 2013 to December 2016. Primary language, last known well-to-door time, door-to-imaging time, and door-to-needle time were abstracted from chart review. The patients were divided into English and non-English speaking groups. Non-English speaking patients were further divided into Spanish, Vietnamese, and an Other language group (including Korean, Punjabi, Romanian, Cantonese, Mandarin, Tagalog and Arabic). Student’s t-test and an ANOVA with Tukey post-hoc test were used to analyze differences between groups.
Results: During the 4-year study period, 190 patients received IV tPA for acute ischemic stroke. Among them, 120 were English speaking and 70 non-English speaking. The non-English speaking patients included 35 Spanish, 22 Vietnamese, and 13 other language-speaking minorities. Between the non-English and English speaking groups there was no significant difference in average last known well-to-door-time (70.2 minutes vs 65.8 minutes, p=0.42), door-to-imaging time (14.3 minutes vs 16.5 minutes, p=0.07), and door-to-needle time for IV tPA (47.5 minutes vs 50.3 minutes, p=0.42). Subgroup analyses comparing English, Spanish, Vietnamese and Other language groups also showed no significant differences between the groups.
Conclusions: Primary language had no effect on timely acute stroke management for IV tPA recipients in our center. This was likely due to physician/staff diversity, the availability of interpreters, and English-speaking family members or friends. While our study focused on patients that received tPA, we suspect that primary language may influence the last known well-to-door time for all ischemic stroke patients, thereby limiting the number of non-English speaking patients eligible to receive tPA.