The purpose of this study is to investigate the impact of language barrier on the time to treatment decision. Our goal is to guide criteria for interpreter use during the critical time period of stroke presentation.

The NIHSS assigns 5 points for language-specific tasks. Moreover in non-verbal patients, tPA administration decisions necessitate discussions with next of kin. Language barriers might result in significant time delays in the critical treatment window.  

We performed a retrospective analysis of all cases of acute stroke that received tPA at a tertiary,urban academic medical center  in the Northeastern USA, in 2018-2019 English proficiency was defined as need for interpreter for routine medical care. The main endpoint was average time to treatment in English-proficient vs English non-proficient patients.. We performed univariable comparisons of average time to treatment. We further stratified our analysis by medical complexity. Medically complex cases were defined as cases with logistical barriers, and relative contraindications that required additional investigation prior to decision making

Our cohort comprised 43 English-proficient patients (21% male, mean age 73± 16 years) and 10 English non-proficient (50% male, mean age 76±13 years. Time-to-treatment in English-proficient patients was 0:58±0.019 vs 65±0.015 mins (p=0.27). When excluding medically complex cases, time-to-treatment in English-proficient patients was 49±0.01 vs 64±0.02 mins in English non-proficient patients (p=0.017) There was no significant difference in age or sex between the groups.

In this retrospective single-center study we found that in medically non-complex patients with acute ischemic stroke, there was a significantly shorter time to treatment in English-proficient patients vs English non-proficient. Our findings suggest that language barrier might be an important cause of delay in thrombolysis. Future multicenter studies with larger sample size in diverse environments are needed to further address this potentially addressable impediment to timely treatment.