Abstract WP213: Impact of Language Barriers on Acute Intracerebral Hemorrhage Management and Outcomes

Hematoma expansion in ICH is associated with worse outcome. A multitude of factors contribute to reduction of expansion, including rapid detection, sustained BP control and reversal of anticoagulation. Prevention of ICH expansion relies heavily on timely communication, which may be delayed by barriers to effective patient-to-provider interaction. While there have been studies examining the relationship between language barriers (LB) and outcomes in ischemic stroke, not much is known regarding LB and ICH. The purpose of this study is to determine the impact of LB on ICH care and outcomes. We performed retrospective analysis of 200 ICH patients presenting to a single academic Comprehensive Stroke Center (CSC) 2018-2024. Data included LKW, ED arrival, severity of presenting symptoms (GCS), location (deep vs lobar), UTox, SBP on ED arrival, time to CT, time to improve SBP <140 mmHg, decision for surgery, time to surgery, disability (90 day MRS), decision for tracheostomy/gastrostomy, and decision for comfort care. Of patients evaluated, 60% were fluent in English compared to 40% with LB (33% Spanish, 37% Vietnamese, 4% Korean, 2.5% other Asian language). Average age was 63 in the English group and 65 in the LB group. The majority were male. Patients with LB tended to present later to ED. There was also a higher average time to CTH in the LB group. Patients with LB were significantly more likely to have mixed hemorrhage (p=0.03). Interestingly, patients with LB had statistically significantly higher SBP on ED arrival (p=0.01), but English speakers were more likely to have ICH expansion (23%, 15%, p=0.06). There was no significant difference in time required to control SBP, rates of surgery, time to surgery, decision for comfort care, nor for tracheostomy/PEG. Patients with LB tended to have better 90 day mRS. In subgroup analysis comparing 90 day mRS in English vs Spanish, English vs Asian, and Spanish vs Asian, there was no statistically significant difference. Our results demonstrate despite a trend toward later arrival, initial imaging, and higher initial SBP in the LB group, there was no statistically significant difference in acute management nor outcome in ICH. Our findings highlight the efficiency of stroke system of care at an academic CSC in delivering high quality, consistent care to diverse populations, regardless of their English skills. These findings warrant further investigation into awareness of ICH symptoms and its care in patients with LB.