Abstract Body: Introduction
An equitable health system requires access to clinical advances across society. In stroke, mechanical thrombectomy (MT) has revolutionized the field by providing an acute therapy with unprecedented reduction in morbidity and mortality. Its benefit depends heavily on the duration between stroke onset and cerebral reperfusion. As such, patient factors associated with delays in care can influence outcomes after MT and lead to health inequities. Communication is paramount to a neurological evaluation. In a predominantly English-speaking medical system, we hypothesized that patients with a primary language other than English who presented to the hospital with large-vessel occlusion ischemic stroke (LVO) might experience delays in care resulting in longer times to MT.
Methods
We conducted a single-center retrospective cohort study to investigate the impact of primary language on door-to-puncture time (DTP) among patients with LVO who presented to a single comprehensive stroke center between 01/2020 and 05/2024 and underwent MT. We employed non-parametric statistics to compare patient demographics and clinical outcomes and a LASSO approach to identify independent predictors of DTP.
Results
Of the 413 patients who underwent MT, 52 (13%) were non-English-speaking (Table 1). In the overall cohort, patients were on average 71 years of age and majority male (57%). They presented to the hospital 8.1 hours after last known well with a mean NIHSS of 19. Compared with the English-speaking cohort, non-English-speaking patients presented earlier to the hospital after last known well (6.1 hours versus 8.1 hours, p = 0.110), were more likely to receive thrombolysis (33% versus 14%, p < 0.001), and had higher rates of hypertension (63% versus 44%, p < 0.008) and lower rates of congestive heart failure (12% versus 30%, p = 0.005). Neither DTP (60 minutes versus 60 minutes, p = 0.900) nor door to needle time (time to administration of thrombolytic, 43 minutes versus 47 minutes, p = 0.600) differed between non-English and English-speaking patients. Regression analysis identified a history of dyslipidemia (decreased DTP 8 min, 95% CI 2-14 min) and having received IV thrombolysis (increased DTP 13 min, 95% CI 5-21 min), but not primary language, as independent predictors of DTP.
Conclusions
Our comprehensive stroke center promotes an equitable health system by providing a timely opportunity for MT after LVO irrespective of patient language.