Language Discordance in Telestroke Thrombolysis Recommendations

It is unknown if language discordance between patient and provider during telestroke evaluations involves differences in stroke metrics, severity, or outcomes when compared to language concordant (LC) situations. We sought to evaluate differences in patient demographics, stroke severity, and treatment times for patients where intravenous thrombolysis was recommended for suspected acute ischemic stroke (AIS) between LC and language discordant (LD) patient and physician encounters.

This cross-sectional study was a retrospective analysis of prospectively collected data after recommendation to administer intravenous tissue plasminogen activator (IV tPA) between July 2017 and July 2020. Consecutive patients where thrombolysis was recommended for suspected AIS were included, from a single academic center telestroke network with multiple spoke sites. Primary language, time of telestroke evaluation, time to IV tPA recommendation, initial National Institutes of Health Stroke Scale, and demographic information were abstracted. Data were dichotomized into LC for English-speaking patients and providers vs. LD for non-English-speaking patients with English-speaking providers.

A total of 705 LC patient encounters and 42 LD patient encounters were identified. LD patients were older (70 years versus 65 years, p = 0.04) and had a trend to higher stroke severity (median NIHSS 7 versus 6, p = 0.09) than LC patients. Limited outcome data were available only for patients transferred to the comprehensive stroke center hub for a higher level of care or consideration for endovascular thrombectomy, but no significant outcome findings were seen.

LD patients who are evaluated via telestroke were significantly older and had a trend to higher stroke severity as measured by initial NIHSS. Further dedicated data collection on the effects of language in acute stroke metrics in larger cohorts is necessary.