Stroke Screening Process for Spanish-Speaking Patients

The Balance Eyes Face Arms Speech Time stroke screening tool may have limitations for Spanish-speaking individuals. The purpose of this study is to identify potential screen failure events during evaluation for intervenable acute ischemic stroke events among Spanish-speaking patients.

This is a retrospective, observational, single-center study at an urban academic center during 2020. Patients with a positive stroke screen were stratified by Spanish or non-Spanish. We measured last known well, sensitivity, specificity, negative predictive value, and positive predictive value of the emergency department provider's decision to escalate to complete stroke evaluation with acute ischemic stroke as the outcome of interest.

Among 796 patients (mean age of 52 years, 56% female, 37% Spanish speaking), 30% of patients with positive stroke screen were converted to complete stroke evaluation. For provider escalation to complete stroke evaluation for the outcome of acute ischemic stroke events, prevalence was 13%, sensitivity 81%, positive predictive value 22%, and negative predictive value 97% for the overall sample. Spanish-speaking patients were less likely to progress from screening to complete stroke evaluation (25.8% vs 32.8%; 95% for difference CI, 0.57-13.5). Importantly, there was no difference in rate of acute ischemic stroke between Spanish- and non-Spanish-speaking patients.

Over 1 year, with 796 patients triggered at triage by Balance Eyes Face Arms Speech Time for positive stroke screens, only 13% resulted in an acute ischemic stroke. Spanish-speaking patients were less likely to progress from screening to complete stroke evaluation, but the rate of acute ischemic stroke was not different by language.