Barriers to Prompt Presentation to Emergency Departments in Colorado after Onset of Stroke Symptoms

Stroke Screening Process for Spanish-Speaking Patients

INTRODUCTION

The Balance Eyes Face Arms Speech Time stroke screening tool may have limitations for Spanish-speaking individuals. The purpose of this study is to identify potential screen failure events during evaluation for intervenable acute ischemic stroke events among Spanish-speaking patients.

METHODS

This is a retrospective, observational, single-center study at an urban academic center during 2020. Patients with a positive stroke screen were stratified by Spanish or non-Spanish. We measured last known well, sensitivity, specificity, negative predictive value, and positive predictive value of the emergency department provider's decision to escalate to complete stroke evaluation with acute ischemic stroke as the outcome of interest.

RESULTS

Among 796 patients (mean age of 52 years, 56% female, 37% Spanish speaking), 30% of patients with positive stroke screen were converted to complete stroke evaluation. For provider escalation to complete stroke evaluation for the outcome of acute ischemic stroke events, prevalence was 13%, sensitivity 81%, positive predictive value 22%, and negative predictive value 97% for the overall sample. Spanish-speaking patients were less likely to progress from screening to complete stroke evaluation (25.8% vs 32.8%; 95% for difference CI, 0.57-13.5). Importantly, there was no difference in rate of acute ischemic stroke between Spanish- and non-Spanish-speaking patients.

DISCUSSION

Over 1 year, with 796 patients triggered at triage by Balance Eyes Face Arms Speech Time for positive stroke screens, only 13% resulted in an acute ischemic stroke. Spanish-speaking patients were less likely to progress from screening to complete stroke evaluation, but the rate of acute ischemic stroke was not different by language.

Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective

Background and purpose

Stroke is a leading cause of morbidity and mortality worldwide. Developing countries, however, still lag behind in providing timely thrombolytic therapy (TLT) to many eligible patients owing to various reasons. This study aims to identify such factors.

Materials and methods

This was a descriptive observational study undertaken over a period of 18 months at a tertiary care teaching hospital and included 252 acute ischemic stroke patients of which 200 were not thrombolyzed. The reasons for nonthrombolysis were recorded and analyzed.

Results

The study included 252 acute ischemic stroke patients of which only 20% were thrombolyzed. Of the 200 nonthrombolyzed patients, 55% arrived out of the window period while patient-related factors were the second biggest factor preventing thrombolysis. Hospital factors at 14% and financial constraints at 4.5% contributed significantly. Delayed consent emerged as an important factor making 6% of the delays.

Conclusion

Stroke thrombolysis still faces various pre- and intrahospital barriers in India. There is an urgent need to improve infrastructure and organizational streamlining to enable eligible patients to receive prompt treatment.

How to cite this article

Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023;27(9):616-619.