title: Language barriers between physicians and patients are not associated with thrombolysis of stroke mimics.
abstract: BACKGROUND
  Acute stroke is a time-sensitive condition in which rapid diagnosis must be made in order for thrombolytic treatment to be administered. A certain proportion of patients who receive thrombolysis will be found on further evaluation to have a diagnosis other than stroke, so-called "stroke mimics." Little is known about the role of language discordance in the emergency department diagnosis of acute ischemic stroke.
  
  
  METHODS
  This is a retrospective analysis of all acute ischemic stroke patients who received IV tissue plasminogen activator (tPA) in our emergency department between July 2011 and December 2015. Baseline characteristics, patient language, and final diagnosis were compared between encounters in which the treating neurologist and patient spoke the same language (concordant cases) and encounters in which they did not (discordant cases).
  
  
  RESULTS
  A total of 350 patients received IV tPA during the study period. English was the primary language for 52.6%, Spanish for 44.9%, and other languages for 2.6%; 60.3% of cases were classified as language concordant and 39.7% as discordant. We found no significant difference in the proportion of stroke mimics in the language concordant compared to discordant groups (16.6% vs 9.4%,p= 0.06). Similarly, the proportion of stroke mimics did not differ between English- and Spanish-speaking patients (15.8% vs 11.5%,p= 0.27).
  
  
  CONCLUSIONS
  Language discordance was not associated with acute stroke misdiagnosis among patients treated with IV tPA. Prospective evaluation of communication during acute stroke encounters is needed to gain clarity on the role of language discordance in acute stroke misdiagnosis.
authors.affiliation: Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Rostanski
authors.affiliation: Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY.
authors.forename: Olajide
authors.initials: O
authors.lastname: Williams
authors.affiliation: Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY.
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Stillman
authors.affiliation: Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY.
authors.forename: Randolph S
authors.initials: RS
authors.lastname: Marshall
authors.affiliation: Departments of Neurology (SKR, OW, RSM, JZW) and Emergency Medicine (JIS), Columbia University Medical Center, New York, NY.
authors.forename: Joshua Z
authors.initials: JZ
authors.lastname: Willey