Stroke Prognostic Scores and Data-Driven Prediction of Clinical Outcomes After Acute Ischemic Stroke

Background and Purpose— Several stroke prognostic scores have been developed to predict clinical outcomes after stroke. This study aimed to develop and validate novel data-driven predictive models for clinical outcomes by referring to previous prognostic scores in patients with acute ischemic stroke in a real-world setting. Methods— We used retrospective data of 4237 patients with acute ischemic stroke who were hospitalized in a single stroke center in Japan between January 2012 and August 2017. We first validated point-based stroke prognostic scores (preadmission comorbidities, level of consciousness, age, and neurological deficit [PLAN] score, ischemic stroke predictive risk score [IScore], and acute stroke registry and analysis of Lausanne [ASTRAL] score in all patients; Houston intraarterial recanalization therapy [HIAT] score, totaled health risks in vascular events [THRIVE] score, and stroke prognostication using age and National Institutes of Health Stroke Scale-100 [SPAN-100] in patients who received reperfusion therapy) in our cohort. We then developed predictive models using all available data by linear regression or decision tree ensembles (random forest and gradient boosting decision tree) and evaluated their area under the receiver operating characteristic curve for clinical outcomes after repeated random splits. Results— The mean (SD) age of the patients was 74.7 (12.9) years and 58.3% were men. Area under the receiver operating characteristic curves (95% CIs) of prognostic scores in our cohort were 0.92 PLAN score (0.90–0.93), 0.86 for IScore (0.85–0.87), 0.85 for ASTRAL score (0.83–0.86), 0.69 for HIAT score (0.62–0.75), 0.70 for THRIVE score (0.64–0.76), and 0.70 for SPAN-100 (0.63–0.76) for poor functional outcomes, and 0.87 for PLAN score (0.85–0.90), 0.88 for IScore (0.86–0.91), and 0.88 ASTRAL score (0.85–0.91) for in-hospital mortality. Internal validation of data-driven prediction models showed that their area under the receiver operating characteristic curves ranged between 0.88 and 0.94 for poor functional outcomes and between 0.84 and 0.88 for in-hospital mortality. Ensemble models of a decision tree tended to outperform linear regression models in predicting poor functional outcomes but not in predicting in-hospital mortality. Conclusions— Stroke prognostic scores perform well in predicting clinical outcomes after stroke. Data-driven models may be an alternative tool for predicting poststroke clinical outcomes in a real-world setting.

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Serum Iron for Prognosis of Acute Ischemic Stroke by Endovascular Treatment

10.21203/rs.3.rs-17447/v1 ◽

2020 ◽

Author(s):

Mingli Liu ◽

Zhongfei Hao ◽

Ruiyan Li ◽

Jinquan Cai ◽

Yongli Li ◽

...

Keyword(s):

Ischemic Stroke ◽

Retrospective Study ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Receiver Operating Characteristic ◽

Clinical Outcomes ◽

Serum Iron ◽

Operating Characteristic ◽

Iron Level ◽

Serum Iron Level

Abstract Background Iron, as an import micronutrient, is related to many diseases in a human body. Although the function of iron in acute ischemic stroke is yet debatable, there are few reports from clinical data on serum iron for the prognosis of acute ischemic stroke by endovascular treatment. The current retrospective study aimed to investigate the correlation between serum iron and acute ischemic stroke prognosis by endovascular treatment.Methods This study was carried out retrospectively and 84 patients participated from March 2016 to April 2019 who suffered acute ischemic stroke and were treated by endovascular treatment at this stroke center. The laboratory test and clinical data were assessed for the prognosis of acute ischemic stroke by endovascular treatment. An independent relationship was analyzed through binary logistic analysis and receiver operating characteristic curves for the accuracy of the test.Results This retrospective study was carried out at Harbin Medical University’s Second Affiliated Hospital, and enrolled 84 patients from March 2018 to September 2019, including 32 patients in whom the outcomes were clinically favorable and 52 patients with unfavorable clinical outcomes. The groin puncture to recanalization time significantly varied between patients with favorable as well as unfavorable clinical outcomes (45.0 min vs 72.5 min, p = 0.001), serum iron (10.87 μmol/L vs 4.07 μmol/L, p < 0.001) and thrombin time (13.40 s vs 14.25 s, p = 0.034) from univariable analysis. Serum iron (p < 0.001; adjusted OR [95% CI]:70.765 [9.904 - 505.636]) was associated independently with acute ischemic stroke prognosis by endovascular treatment, and receiver operating characteristic showed area under the curve of 0.926 (p < 0.001, 95% CI: 0.872 - 0.979).Conclusions The outcomes of this study reveal that serum iron level was associated independently with acute ischemic stroke prognosis, and high serum iron level could predict favorable clinical outcomes with a significantly accurate ability. Thus, serum iron could be a marker for acute ischemic stroke prognosis through endovascular treatment.

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Abstract 4030: Infarct Volume Thresholds for Prediction of Independent Functional Outcomes after Acute Ischemic Stroke

Stroke ◽

10.1161/str.43.suppl_1.a4030 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Raul G Nogueira ◽

Tudor Jovin ◽

David Liebeskind ◽

Leticia M Souza ◽

Qing Hao ◽

...

Keyword(s):

Ischemic Stroke ◽

Stroke Volume ◽

Acute Ischemic Stroke ◽

Receiver Operating Characteristic ◽

Functional Outcome ◽

Functional Outcomes ◽

Operating Characteristic ◽

Infarct Volume ◽

Roc Curves ◽

The Mean

Background and Purpose: The main premise of reperfusion therapy in acute ischemic stroke (AIS) is to prevent the conversion of the salvable penumbra into irreversible infarct core thereby reducing the final stoke size. Indeed, previous studies have demonstrated a strong correlation between final infarct volumes and functional outcomes. We sought to establish the optimal final infarct thresholds that best correlate with independent functional outcomes. Methods: Multicenter retrospective analysis across five large academic centers. Consecutive patients meeting the following criteria were included: (1) anterior circulation stroke; (2) available final stroke imaging volumetric analysis; (3) available modified Rankin scale (mRS) score at 90 days. Receiver operating characteristic (ROC) curves were created to help defining the optimal final stroke volume points that discriminate a 90-day mRS ≤2. Results: A total of 484 consecutive patients were identified. The mean age was 65.6±14.6 years. The mean baseline NIHSS was 14.2±7.1. The mean final stroke volume was 77.7±88.5cc (median, 40.5cc). A total of 201 out of the 484 (41.5%) of the patients achieved functional independence at 90 days. The ROC analysis demonstrated that final infarct volume (FIV) was a strong discriminator of independent outcomes with an area under the curve [AUC] of 0.778. The best cut-off point for discriminating 90-day mRS ≤2 was 35cc of FIV (70% specificity; 70% sensitivity). The AUC could be improved by excluding older patients. In patient <65 years, the AUC was 0.844 with an optimal discriminating point at 53cc (75% specificity; 75% sensitivity). The exclusion of patients >80 years yielded an AUC of 0.797 with an optimal FIV discriminating point at 40cc (72% specificity; 72% sensitivity). In this population, FIV of 29cc had 80% specificity and 62% sensitivity whereas FIV of 15cc had 90% specificity but only 40% sensitivity for an independent functional outcome. Conclusions: Final infarct volume is a strong surrogate for good outcomes after AIS. Our data suggest that the exclusion of patients with infarct volumes >35-40cc on baseline imaging may enhance the chances of a positive confirmatory clinical trial of reperfusion in AIS. Figure: Receiver operating characteristic (ROC) curves of Final Stroke Volume (cc) and Independent Functional Outcome (mRS ≤2) at 90 days.

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Elevated total homocysteine predicts in-hospital pneumonia and poor functional outcomes in acute ischemic stroke

10.21203/rs.2.22904/v1 ◽

2020 ◽

Author(s):

Shoujiang You ◽

Lixuan Wang ◽

Huaping Du ◽

Danni Zheng ◽

Chongke Zhong ◽

...

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Fold Increase ◽

Short Term ◽

Thcy Level ◽

Poor Outcome ◽

Total Homocysteine ◽

The Impact

Abstract Background The impact of elevated total homocysteine (tHcy) on functional outcomes and pneumonia after acute ischemic stroke (AIS) is still not well understood. We investigated the association between tHcy levels upon hospital admission and in-hospital short-term outcomes in AIS patients. Methods A total of 2,084 AIS patients enrolled from December 2013 to May 2014 across 22 hospitals in Suzhou city were included in the present study. We divided patients into 4 groups according to their level of admission tHcy: Q1 (<9.70 umol/L), Q2 (9.70-12.3 umol/L), Q3 (12.3-16.9 umol/L), and Q4 (≥16.9 umol/L). Logistic regression models were used to estimate the effect of tHcy on the short-term outcomes, including in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge (modified Rankin Scale score ≥3) in AIS patients. Results During hospitalization, 332 patients (15.9%) had pneumonia, 57 patients (2.7%) died from all causes and 784 (37.6%) patients experienced poor outcome at discharge. The risk of in-hospital pneumonia was significantly higher in patients with highest tHcy level (Q4) compared to those with lowest (Q1) (adjusted odds ratio [OR] 1.55; 95% confidence interval [CI], 1.03-2.33; P -trend =0.019). The highest tHcy level (Q4) was associated with a 3.35-fold and 1.50-fold increase in the risk of in-hospital mortality(adjusted OR 3.35; 95% CI, 1.11–10.13; P -trend =0.015) and poor outcome upon discharge(adjusted OR 1.50; 95% CI, 1.06–2.12; P -trend =0.044) in comparison to Q1 after adjustment for potential covariates including pneumonia. Subgroup analyses further confirmed a significant association between higher tHcy levels and a high risk of short-term outcomes. Conclusions Having a high admission tHcy level was independently associated with in-hospital pneumonia, all cause in-hospital mortality and poor outcome upon discharge in AIS patients. Moreover, the association between higher tHcy and poor functional outcome was not modified by pneumonia.

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Association of Serum Fatty Acids at Admission with the Age of Onset of Acute Ischemic Stroke

Nutrients ◽

10.3390/nu12082411 ◽

2020 ◽

Vol 12 (8) ◽

pp. 2411 ◽

Cited By ~ 1

Author(s):

Takahisa Mori ◽

Kazuhiro Yoshioka ◽

Yuhei Tanno ◽

Shigen Kasakura

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Age Of Onset ◽

Linear Regression Analysis ◽

Multiple Linear Regression Analysis ◽

Characteristic Curves ◽

Receiver Operating Characteristic Curves ◽

Receiver Operating

Dietary triglycerides influence fatty acid (FA) serum concentrations and weight percentages (wt %), which may be associated with the age of onset of acute ischemic stroke (AIS). We investigated the correlations between serum FA levels and proportions at admission and the age of onset of AIS. We evaluated patients with AIS admitted between 2016 and 2019 within 24 h of AIS onset and calculated the correlation coefficients between their ages, serum FA concentrations, and FA wt % values. Multiple linear regression analysis was performed to identify independent FAs indicating AIS age of onset. Furthermore, we estimated the threshold values of independent FAs for age of onset <60 years using receiver operating characteristic curves by logistic regression. A total of 525 patients (median age: 75 years) met the inclusion criteria. The concentration of dihomo-gamma-linolenic acid (DGLA) and wt % of docosahexaenoic acid (DHA) were significant independent variables for age of onset of AIS, and receiver operating characteristic curves for age of onset <60 years showed thresholds of ≥117.7 µmol/L for DGLA and ≤3.7% for DHA. An increased DGLA concentration and decreased DHA wt % were significantly associated with onset of AIS at a younger age.

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Utility of single-energy and dual-energy computed tomography in clot characterization: An in-vitro study

Interventional Neuroradiology ◽

10.1177/1591019917694479 ◽

2017 ◽

Vol 23 (3) ◽

pp. 279-284 ◽

Cited By ~ 7

Author(s):

Waleed Brinjikji ◽

Gregory Michalak ◽

Ramanathan Kadirvel ◽

Daying Dai ◽

Michael Gilvarry ◽

...

Keyword(s):

Computed Tomography ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Area Under The Curve ◽

In Vitro Study ◽

Dual Energy ◽

Dual Energy Ct

Background and purpose Because computed tomography (CT) is the most commonly used imaging modality for the evaluation of acute ischemic stroke patients, developing CT-based techniques for improving clot characterization could prove useful. The purpose of this in-vitro study was to determine which single-energy or dual-energy CT techniques provided optimum discrimination between red blood cell (RBC) and fibrin-rich clots. Materials and methods Seven clot types with varying fibrin and RBC densities were made (90% RBC, 99% RBC, 63% RBC, 36% RBC, 18% RBC and 0% RBC with high and low fibrin density) and their composition was verified histologically. Ten of each clot type were created and scanned with a second generation dual source scanner using three single (80 kV, 100 kV, 120 kV) and two dual-energy protocols (80/Sn 140 kV and 100/Sn 140 kV). A region of interest (ROI) was placed over each clot and mean attenuation was measured. Receiver operating characteristic curves were calculated at each energy level to determine the accuracy at differentiating RBC-rich clots from fibrin-rich clots. Results Clot attenuation increased with RBC content at all energy levels. Single-energy at 80 kV and 120 kV and dual-energy 80/Sn 140 kV protocols allowed for distinguishing between all clot types, with the exception of 36% RBC and 18% RBC. On receiver operating characteristic curve analysis, the 80/Sn 140 kV dual-energy protocol had the highest area under the curve for distinguishing between fibrin-rich and RBC-rich clots (area under the curve 0.99). Conclusions Dual-energy CT with 80/Sn 140 kV had the highest accuracy for differentiating RBC-rich and fibrin-rich in-vitro thrombi. Further studies are needed to study the utility of non-contrast dual-energy CT in thrombus characterization in acute ischemic stroke.

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Infarct-core CT perfusion parameters in predicting post-thrombolysis hemorrhagic transformation of acute ischemic stroke

Radiology and Oncology ◽

10.2478/raon-2018-0048 ◽

2018 ◽

Vol 53 (1) ◽

pp. 25-30 ◽

Cited By ~ 2

Author(s):

Crt Langel ◽

Katarina Surlan Popovic

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Receiver Operating Characteristic ◽

Operating Characteristic ◽

Receiver Operating Characteristic Analysis ◽

Ct Perfusion ◽

Hemorrhagic Transformation ◽

Characteristic Analysis ◽

Infarct Core ◽

Receiver Operating

Abstract Background Intravenous thrombolysis (IVT) is the method of choice in reperfusion treatment of patients with signs and symptoms of acute ischemic stroke (AIS) lasting less than 4.5 hours. Hemorrhagic transformation (HT) of acute ischemic stroke is a serious complication of IVT and occurs in 4.5–68.0% of clinical cases. The aim of our study was to determine the infarct core CT perfusion parameter (CTPP) most predictive of HT. Patients and methods Seventy-five patients with AIS who had undergone CT perfusion (CTP) imaging and were treated with IVT were enrolled in this retrospective study. Patients with and without HT after IVT were defined as cases and controls, respectively. Controls were found by matching for time from AIS symptom onset to IVT ± 0.5 h. The following CTPPs were measured: cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), relative CBF (rCBF) and relative CBV (rCBV). Receiver operating characteristic analysis curves of significant CTPPs determined cut-off values that best predict HT. Results There was a significant difference between cases and controls for CBF (p = 0.004), CBV (p = 0.009), rCBF (p < 0.001) and rCBV (p = 0.001). Receiver operating characteristic analysis revealed that rCBF < 4.5% of the contralateral mean (area under the curve = 0.736) allowed prediction of HT with a sensitivity of 71.0% and specificity of 52.5%. Conclusions CTP imaging has a considerable role in HT prediction, assisting in selection of patients that are likely to benefit from IVT. rCBF proved to have the highest HT predictive value.

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Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016930 ◽

2020 ◽

pp. neurintsurg-2020-016930

Author(s):

Osama O Zaidat ◽

Marc Ribo ◽

Heinrich Paul Mattle ◽

Jeffrey L Saver ◽

Hormozd Bozorgchami ◽

...

Keyword(s):

United States ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Economic Impact ◽

Clinical Outcomes ◽

Resource Use ◽

Functional Outcomes ◽

Healthcare Resource ◽

Healthcare Resource Use ◽

First Pass

BackgroundFirst-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed.ObjectiveTo assess the economic impact of achieving complete or near complete reperfusion after the first pass.MethodsPost hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c–3 was achieved, stratified into two groups: (1) mTICI 2c–3 achieved after the first pass (FPE group) or (2) after multiple passes (non-FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were compared between groups. Costs from peer-reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK).ResultsAmong patients who achieved mTICI 2c–3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90-day modified Rankin Scale score 0–2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non-FPE group required at least one additional device. Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization-related (24–33% reduction) and annual care (11–27% reduction) costs across all countries.ConclusionsFPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs.

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Influence of Estimated Glomerular Filtration Rate on Clinical Outcomes in Patients with Acute Ischemic Stroke Not Receiving Reperfusion Therapies

Journal of Clinical Medicine ◽

10.3390/jcm10204719 ◽

2021 ◽

Vol 10 (20) ◽

pp. 4719

Author(s):

Mi-Yeon Eun ◽

Jin-Woo Park ◽

Bang-Hoon Cho ◽

Kyung-Hee Cho ◽

Sungwook Yu

Keyword(s):

Ischemic Stroke ◽

Glomerular Filtration Rate ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Filtration Rate ◽

Estimated Glomerular Filtration Rate ◽

Independent Predictor ◽

Reperfusion Therapy ◽

Hemorrhagic Transformation

Background: We aimed to determine whether estimated glomerular filtration rate (eGFR) is an independent predictor of clinical outcomes in patients with acute ischemic stroke not treated with reperfusion therapy. Methods: A total of 1420 patients with acute ischemic stroke from a hospital-based stroke registry were included in this study. Patients managed with intravenous thrombolysis or endovascular reperfusion therapy were excluded. The included patients were categorized into five groups according to eGFR, as follows: ≥90, 60–89, 45–59, 30–44, and <30 mL/min/1.73 m2. The effects of eGFR on functional outcome at discharge, in-hospital mortality, neurologic deterioration, and hemorrhagic transformation were evaluated using logistic regression analyses. Results: In univariable logistic regression analysis, reduced eGFR was associated with poor functional outcome at discharge (p < 0.001) and in-hospital mortality (p = 0.001), but not with neurologic deterioration and hemorrhagic transformation. However, no significant associations were observed between eGFR and any clinical outcomes in multivariable analysis after adjusting for clinical and laboratory variables. Conclusions: Reduced eGFR was associated with poor functional outcomes at discharge and in-hospital mortality but was not an independent predictor of short-term clinical outcomes in patients with acute ischemic stroke who did not undergo reperfusion therapy.

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Abstract 14739: Temporal Trends, Predictors and Outcomes of Acute Ischemic Stroke in Acute Myocardial Infarction in the United States

Circulation ◽

10.1161/circ.142.suppl_3.14739 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Sri Harsha Patlolla ◽

Gaurav Aggarwal ◽

Saurabh Aggarwal ◽

Saraschandra Vallabhajosyula

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Ischemic Stroke ◽

Coronary Angiography ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Functional Outcomes ◽

Temporal Trends ◽

Hospitalization Costs

Introduction: There are limited contemporary data on prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI). Methods: Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000-2017) were evaluated for in-hospital AIS. Outcomes of interest included in-hospital mortality, hospitalization costs, length of stay, and use of tracheostomy and percutaneous endoscopic gastrostomy (PEG). The discharge destination was used to classify AIS survivors into good and poor functional outcomes with poor (moderate to severe disability) defined as discharge to extended care facility including short-term hospital/rehabilitation facility, intermediate care or long-term care facilities. Results: Of a total 11,622,528 AMI admissions, 183,896 (1.6%) had concomitant AIS. Over the 18-year period, AIS rates were stable in STEMI admissions and decreased in NSTEMI (p<0.001). Compared to those without, the AIS cohort was on average older, female, of non-White race, with greater comorbidities, and higher rates of arrhythmias. The AMI-AIS admissions received less frequent coronary angiography (46.9% vs. 63.8%) and percutaneous coronary angiography (22.7% vs 41.8%) (p<0.001). Female sex, non-White race, higher comorbidity, ST-segment-elevation AMI presentation, atrial fibrillation/flutter, use of mechanical circulatory support and invasive mechanical ventilation were identified as individual predictors of AIS after AMI. The AIS cohort had higher in-hospital mortality (16.4% vs. 6.0%; adjusted OR 1.75 [95% CI 1.72-1.78]; p<0.001) with a steady decrease in the adjusted in-hospital mortality in over the 18-year period (21% in 2000 vs 17% in 2017). The AIS cohort had longer hospital length of stay, higher hospitalization costs, greater use of tracheostomy and PEG, and less frequent discharges to home (all p<0.001). In AMI-AIS survivors (N=153,318), 57.3% had a poor functional outcome with temporal trends showing a slight increase in recent years (57% in 2000 vs 62% in 2017). Conclusions: AIS is associated with significantly higher in-hospital mortality and poor functional outcomes in AMI admissions. Despite improvement in in-hospital mortality, poor functional outcomes remain high.

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Disparities in Care and Outcome of Stroke Patients from Culturally and Linguistically Diverse Communities in Metropolitan Australia

Journal of Clinical Medicine ◽

10.3390/jcm10245870 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5870

Author(s):

Fatemeh Rezania ◽

Christopher J. A. Neil ◽

Tissa Wijeratne

Keyword(s):

Ischemic Stroke ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Stroke Unit ◽

Language Barriers ◽

Language Barrier ◽

Residential Aged Care ◽

Stroke Severity ◽

English Speaking

Background: Acute stroke is a time-critical emergency where diagnosis and acute management are highly dependent upon the accuracy of the patient’s history. We hypothesised that the language barrier is associated with delayed onset time to thrombolysis and poor clinical outcomes. This study aims to evaluate the effect of language barriers on time to thrombolysis and clinical outcomes in acute ischemic stroke. Concerning the method, this is a retrospective study of all patients admitted to a metropolitan stroke unit (Melbourne, Victoria, Australia) with an acute ischemic stroke treated with tissue plasminogen activator between 1/2013 and 9/2017. Baseline characteristics, thrombolysis time intervals, length of stay, discharge destination, and in-hospital mortality were compared among patients with and without a language barrier using multivariate analysis after adjustment for age, sex, stroke severity, premorbid modified Rankin Scale (mRS), and Charlson Comorbidity Index (CCI). Language barriers were defined as a primary language other than English. A total of 374 patients were included. Our findings show that 76 patients (20.3%) had a language barrier. Mean age was five years older for patients with language barriers (76.7 vs. 71.8 years, p = 0.004). Less non-English speaking patients had premorbid mRS score of zero (p = 0.002), and more had premorbid mRS score of one or two (p = 0.04). There was no statistically significant difference between the two groups in terms of stroke severity on presentation (p = 0.06). The onset to needle time was significantly longer in patients with a language barrier (188 min vs. 173 min, p = 0.04). Onset to arrival and door to imaging times were reassuringly similar between the two groups. However, imaging to needle time was 9 min delayed in non-English speaking patients with a marginal p value (65 vs. 56 min, p = 0.06). Patients with language barriers stayed longer in the stroke unit (six vs. four days, p = 0.02) and had higher discharge rates than residential aged care facilities in those admitted from home (9.2% vs. 2.3%, p = 0.02). In-hospital mortality was not different between the two groups (p = 0.8). In conclusion, language barriers were associated with almost 14 min delay in thrombolysis. The delay was primarily attributable to imaging to needle time. Language barriers were also associated with poorer clinical outcomes.

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