Language Discordance in Telestroke Thrombolysis Recommendations.

Area of Science:

• Neurology
• Telemedicine
• Health Equity

Background:

• Language discordance between patients and providers during telestroke evaluations is not well understood regarding stroke metrics, severity, or outcomes.
• This study aimed to compare demographic, stroke severity, and treatment time differences in language-concordant versus language-discordant telestroke encounters.

Purpose of the Study:

• To evaluate differences in patient demographics, stroke severity, and treatment times for patients receiving intravenous thrombolysis recommendations for suspected acute ischemic stroke.
• To compare language-concordant and language-discordant telestroke encounters.

Main Methods:

• A retrospective analysis of prospectively collected data from July 2017 to July 2020 at a single academic center telestroke network.
• Included consecutive patients with suspected acute ischemic stroke where intravenous tissue plasminogen activator (IV tPA) was recommended.
• Data abstracted included primary language, telestroke evaluation time, time to IV tPA recommendation, initial National Institutes of Health Stroke Scale (NIHSS), and demographics. Encounters were dichotomized into Language Concordant (English-speaking patients and providers) versus Language Discordant (non-English speaking patients, English-speaking providers).

Main Results:

• Identified 705 Language Concordant encounters and 42 Language Discordant encounters.
• Language Discordant patients were older (mean age 70 vs. 65 years, p=0.04) and showed a trend towards higher stroke severity (median NIHSS 7 vs. 6, p=0.09).
• Limited outcome data showed no significant findings, with only a subset of patients transferred for higher care or endovascular thrombectomy consideration.

Conclusions:

• Language Discordant patients evaluated via telestroke were significantly older and exhibited a trend toward higher stroke severity based on initial NIHSS scores.
• Further dedicated data collection in larger cohorts is necessary to comprehensively understand the effects of language barriers on acute stroke metrics and patient outcomes.