Impact of Patient Language on Emergency Medical Service Use and Prenotification for Acute Ischemic Stroke

Abstract

Background and Purpose: Use of emergency medical services (EMS) is associated with decreased door-to-needle time in acute ischemic stroke (AIS). Whether patient language affects EMS utilization and prenotification in AIS has been understudied. We sought to characterize EMS use and prenotification by patient language among intravenous tissue plasminogen activator (IV-tPA) tissue plasminogen (IV-tPA) treated patients at a single center with a large Spanish-speaking patient population. Methods: We performed a retrospective analysis of all patients who received IV-tPA in our emergency department between July 2011 and June 2016. Baseline characteristics, EMS use, and prenotification were compared between English-and Spanish-speaking patients. Logistic regression was used to measure the association between patient language and EMS use. Results: Of 391 patients who received IV-tPA, 208 (53%) primarily spoke English and 174 (45%) primarily spoke Spanish. Demographic and clinical factors including National Institutes of Health Stroke Scale (NIHSS) did not differ between language groups. Emergency medical services use was higher among Spanish-speaking patients (82% vs 70%; P < .01). Prenotification did not differ by language (61% vs 63%; P ¼ .8). In a multivariable model adjusted for age, sex, and NIHSS, Spanish speakers remained more likely to use EMS (odds ratio: 1.8, 95% confidence interval: 1.1-3.0). Conclusion: Emergency medical services usage was higher in Spanish speakers compared to English speakers among AIS patients treated with IV-tPA; however, prenotification rates did not differ. Future studies should evaluate differences in EMS utilization according to primary language and ethnicity.

Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke

“…However, previous studies have showed conflicting results on the impact of language barriers. Emergency medical service usage was actually reported higher in the Spanish-speaking patients than the English-speaking patients treated with IVT [18]. A retrospective single-center study showed that language discordance was not associated with acute stroke misdiagnosis among patients treated with IVT [19].…”

Community Socioeconomic Status and Dispatcher-Assisted Cardiopulmonary Resuscitation for Patients with Out-of-Hospital Cardiac Arrest

“…The use of emergency medical services varies among different language-speaking patients [32]. EMS providers should be prepared when responding to emergency calls involving patients with limited language proficiency [33].…”

The Relationship Between Limited English Proficiency and Outcomes in Stroke Prevention, Management, and Rehabilitation: A Systematic Review

“…Two studies found no association between English or non-English preference and either mode of arrival or time to hospital presentation (17,32). Three studies were carried out at the same New York City institution using data from patients who received IV-tPA (18)(19)(20). One found that Spanish speakers were more likely than English speakers to have arrived by EMS after adjusting for confounders, while prenotification rates were not significantly different among those who utilized EMS.…”

“…One found that Spanish speakers were more likely than English speakers to have arrived by EMS after adjusting for confounders, while prenotification rates were not significantly different among those who utilized EMS. Median symptom onset-to-door and DTN times did not differ between Spanish and English speakers (18). A second study investigated the role of language-concordant vs. discordant encounters, defined by whether the primary treating physician and the patient possessed fluency in the same language.…”