To determine if non-English speaking patients experience delays in acute stroke intervention compared to English-speaking patients.

Disease-modifying treatment for stroke depends on rapid evaluation. Communication across language barriers may delay or impair obtaining accurate history, performing elements of the neurological exam, screening for contraindications, and assenting/consenting to treatment.

This is a retrospective study utilizing 305 patients who underwent acute stroke intervention (thrombolysis with alteplase or tenecteplase and/or mechanical thrombectomy) at two urban comprehensive stroke centers 2021-2023. We categorized each patient’s primary speaking language as English, Spanish, or Other. Linear regressions were performed to analyze the entire data set and treatment type subgroups. To account for other causes of treatment delay, we also included the following covariates: low National Institutes of Health Stroke Scale (NIHSS) (NIHSS<4), presence of peri-code medical events (intubation, nausea/vomiting, seizure, agitation), signs of hemodynamic instability, and medical comorbidities and demographic features

Median door-to-needle (DTN) time was 48 minutes. Median door-to-thrombectomy (DTT) time was 142 minutes. Language was associated with delayed DTT in the subset of patients who received both thrombolysis and thrombectomy (p=0.0147). Peri-code nausea/vomiting (p=0.0285), elevated blood pressure (p=0.0419), low NIHSS (p=0.0320), and history of atrial fibrillation (p=0.0331) were associated with longer DTN times in patients who underwent thrombolysis. In the subgroup of patients who underwent thrombolysis without thrombectomy, only a history of atrial fibrillation was associated with increased DTN time (p=0.0212).  Low NIHSS was associated with longer DTT times in all patients who underwent thrombectomy (p<0.001) and the subset of patients who underwent thrombectomy without thrombolysis (p<0.001).