Primary Language Predicts Outcomes In Acute Ischemic Stroke

Objective: This study aimed to determine if primary language impacts outcomes of acute stroke patients receiving IV thrombolysis. Background: Intravenous thrombolysis with tPA is the only FDA-approved medical therapy for acute ischemic stroke. There is a paucity of data regarding the effect of primary language on outcomes in stroke patients. Design/Methods: This is a retrospective study of patients with acute ischemic stroke who received IV tPA at our institution from January 1, 2013 to December 31, 2016. Subjects were divided by primary language. Subgroups for Non-English speakers were Spanish, Vietnamese, and Other-language. Outcomes were modified Rankin scale (mRS) at discharge, favorable outcome (mRS score 0–2) at discharge, mortality at hospital discharge, and length of stay (LOS). Statistical analysis was done with unpaired t-test and ANOVA multi-variant analysis as appropriate. Results: During the study period, 190 patients received IV tPA. Among them, 120 primarily spoke English, 35 Spanish, 22 Vietnamese, and 13 Other-languages. Favorable outcome at discharge was highest in Vietnamese group at 50%, followed by English (48%), Spanish (40%), and Other-language (7.7%). English and Vietnamese groups scored nearly two points better on mRS at discharge than the Other-language group. Mortality rate was highest in the Other-language group at 15.4%, followed by English (9.2%), Vietnamese (4.5%), and Spanish groups (2.9%). English-speaking patients had shorter mean LOS (4.2 days versus 5.2 days; 95% CI 0.068–2.02) compared to Non-English speaking patients. Average LOS for the Other-language group exceeded other groups by one week. The Other-language group was least likely to be discharged home (7.7%) compared to English (34.5%), Spanish (42.9%) and Vietnamese (50.0%) groups. Conclusions: This study demonstrated an outcome advantage for tPA patients whose primary language is more frequent (English, Spanish, Vietnamese) at a multi-ethnic hospital. Patients whose primary language was uncommon had higher mortality rate, longer LOS, and were less likely to be discharged home. Disclosure: Dr. Janarious has nothing to disclose. Dr. Anderson has nothing to disclose. Dr. Yu has nothing to disclose.