Time to endovascular thrombectomy for acute ischaemic stroke in language other than English (LOTE) communities in South-Western Sydney
Background Access to endovascular thrombectomy (EVT) for acute ischaemic stroke (AIS) and the outcome disparities in culturally and linguistically diverse (CALD) populations are understudied. South-Western Sydney (SWS), characterised by high prevalence of CALD populations, provides an ideal setting...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2025-06-01
|
| Series: | BMJ Neurology Open |
| Online Access: | https://neurologyopen.bmj.com/content/7/1/e001114.full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849744187957706752 |
|---|---|
| author | Dennis Cordato Peter Thomas Alan McDougall Cecilia Cappelen-Smith Christopher Blair Nathan Manning Jing ji Longting Lin Mark Parsons Andrew K Cheung Daniel Wardman Chushuang Chen Suzanne J Hodgkinson Helen Badge Vivek Pidugun Timmy Pham |
| author_facet | Dennis Cordato Peter Thomas Alan McDougall Cecilia Cappelen-Smith Christopher Blair Nathan Manning Jing ji Longting Lin Mark Parsons Andrew K Cheung Daniel Wardman Chushuang Chen Suzanne J Hodgkinson Helen Badge Vivek Pidugun Timmy Pham |
| author_sort | Dennis Cordato |
| collection | DOAJ |
| description | Background Access to endovascular thrombectomy (EVT) for acute ischaemic stroke (AIS) and the outcome disparities in culturally and linguistically diverse (CALD) populations are understudied. South-Western Sydney (SWS), characterised by high prevalence of CALD populations, provides an ideal setting to explore these disparities. This study aimed to assess whether being born in a country where English is not the primary language (‘language other than English’; LOTE) affects access to EVT and outcomes for acute ischaemic stroke while also identifying demographic risk factors influencing stroke severity and outcomes.Methods A retrospective cohort study was conducted on consecutive patients with AIS who underwent EVT at Liverpool Hospital, Sydney, from 2018 to 2023. Participants were categorised based on country-of-origin Australia/New Zealand/United Kingdom or LOTE. Primary outcomes included time metrics—onset-to-arrival (OTA) and arrival-to-puncture (ATP)—and 3-month modified Rankin Score (mRS). Statistical analyses included multivariate logistic regression to evaluate predictors of functional outcomes.Results Of 911 EVT referrals, 721 patients were included. LOTE patients (50.3%) were more likely to have diabetes mellitus (30% vs 16%; p<0.001) and presented with higher stroke severity (median National Institutes of Health Stroke Scale (NIHSS) 17 vs 14; p<0.001). They also experienced shorter ATP (158 vs 174 min; p=0.006). Patients requiring interpreters equally exhibited shorter ATP times (152 vs 170 min; p=0.01) and higher stroke severity. There was no significant disadvantage hailing from the LOTE group in OTA times and in any time metrics for subgroup analyses stratified by primary presenter status. However, LOTE patients had poorer 3-month outcomes (mRS ≤2: 46.5% vs 55.4%; p=0.021), which was associated with higher baseline NIHSS and diabetes in adjusted analyses.Conclusion LOTE patients in SWS undergoing EVT were not disadvantaged in hospital time metrics. Poorer 3-month functional outcomes in LOTE patients highlight the need for targeted strategies addressing risk factors, such as diabetes mellitus. |
| format | Article |
| id | doaj-art-1ab4dcfb1d2e4d08bc248eb778a1f1a1 |
| institution | DOAJ |
| issn | 2632-6140 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Neurology Open |
| spelling | doaj-art-1ab4dcfb1d2e4d08bc248eb778a1f1a12025-08-20T03:21:46ZengBMJ Publishing GroupBMJ Neurology Open2632-61402025-06-017110.1136/bmjno-2025-001114Time to endovascular thrombectomy for acute ischaemic stroke in language other than English (LOTE) communities in South-Western SydneyDennis Cordato0Peter Thomas1Alan McDougall2Cecilia Cappelen-Smith3Christopher Blair4Nathan Manning5Jing ji6Longting Lin7Mark Parsons8Andrew K Cheung9Daniel Wardman10Chushuang Chen11Suzanne J Hodgkinson12Helen Badge13Vivek Pidugun14Timmy Pham15South West Sydney Clinical School, UNSW Sydney, Liverpool, NSW, Australia1 Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USADepartment of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, AustraliaSouth Western Sydney Clinical School, University of New South Wales Medicine & Health, Sydney, New South Wales, AustraliaDepartment of Neurology and Neurophysiology, Liverpool Hospital, Liverpool, New South Wales, AustraliaDepartment of Interventional Neuroradiology, Liverpool Hospital, Liverpool, NSW, AustraliaDepartment of Obstetrics and Gynecology, Northwest Women’s and Children’s Hospital, Xi`an, ChinaIngham Institute for Applied Medical Research, Liverpool, New South Wales, AustraliaDepartment of Neurology and Neurophysiology, Liverpol Hospital, Liverpool, NSW, Australia2 Department of Interventional Neuroradiology, Prince of Wales Hospital, NSW, AustraliaSouth Western Sydney Clinical School, University of New South Wales Medicine & Health, Sydney, New South Wales, AustraliaDepartment of Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia2UNSW, Sydney, NSW, AustraliaSouth Western Sydney Clinical School, University of New South Wales Medicine & Health, Sydney, New South Wales, AustraliaNeurology, Liverpool Hospital, Liverpool, New South Wales, AustraliaNeurology, Liverpool Hospital, Liverpool, New South Wales, AustraliaBackground Access to endovascular thrombectomy (EVT) for acute ischaemic stroke (AIS) and the outcome disparities in culturally and linguistically diverse (CALD) populations are understudied. South-Western Sydney (SWS), characterised by high prevalence of CALD populations, provides an ideal setting to explore these disparities. This study aimed to assess whether being born in a country where English is not the primary language (‘language other than English’; LOTE) affects access to EVT and outcomes for acute ischaemic stroke while also identifying demographic risk factors influencing stroke severity and outcomes.Methods A retrospective cohort study was conducted on consecutive patients with AIS who underwent EVT at Liverpool Hospital, Sydney, from 2018 to 2023. Participants were categorised based on country-of-origin Australia/New Zealand/United Kingdom or LOTE. Primary outcomes included time metrics—onset-to-arrival (OTA) and arrival-to-puncture (ATP)—and 3-month modified Rankin Score (mRS). Statistical analyses included multivariate logistic regression to evaluate predictors of functional outcomes.Results Of 911 EVT referrals, 721 patients were included. LOTE patients (50.3%) were more likely to have diabetes mellitus (30% vs 16%; p<0.001) and presented with higher stroke severity (median National Institutes of Health Stroke Scale (NIHSS) 17 vs 14; p<0.001). They also experienced shorter ATP (158 vs 174 min; p=0.006). Patients requiring interpreters equally exhibited shorter ATP times (152 vs 170 min; p=0.01) and higher stroke severity. There was no significant disadvantage hailing from the LOTE group in OTA times and in any time metrics for subgroup analyses stratified by primary presenter status. However, LOTE patients had poorer 3-month outcomes (mRS ≤2: 46.5% vs 55.4%; p=0.021), which was associated with higher baseline NIHSS and diabetes in adjusted analyses.Conclusion LOTE patients in SWS undergoing EVT were not disadvantaged in hospital time metrics. Poorer 3-month functional outcomes in LOTE patients highlight the need for targeted strategies addressing risk factors, such as diabetes mellitus.https://neurologyopen.bmj.com/content/7/1/e001114.full |
| spellingShingle | Dennis Cordato Peter Thomas Alan McDougall Cecilia Cappelen-Smith Christopher Blair Nathan Manning Jing ji Longting Lin Mark Parsons Andrew K Cheung Daniel Wardman Chushuang Chen Suzanne J Hodgkinson Helen Badge Vivek Pidugun Timmy Pham Time to endovascular thrombectomy for acute ischaemic stroke in language other than English (LOTE) communities in South-Western Sydney BMJ Neurology Open |
| title | Time to endovascular thrombectomy for acute ischaemic stroke in language other than English (LOTE) communities in South-Western Sydney |
| title_full | Time to endovascular thrombectomy for acute ischaemic stroke in language other than English (LOTE) communities in South-Western Sydney |
| title_fullStr | Time to endovascular thrombectomy for acute ischaemic stroke in language other than English (LOTE) communities in South-Western Sydney |
| title_full_unstemmed | Time to endovascular thrombectomy for acute ischaemic stroke in language other than English (LOTE) communities in South-Western Sydney |
| title_short | Time to endovascular thrombectomy for acute ischaemic stroke in language other than English (LOTE) communities in South-Western Sydney |
| title_sort | time to endovascular thrombectomy for acute ischaemic stroke in language other than english lote communities in south western sydney |
| url | https://neurologyopen.bmj.com/content/7/1/e001114.full |
| work_keys_str_mv | AT denniscordato timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT peterthomas timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT alanmcdougall timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT ceciliacappelensmith timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT christopherblair timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT nathanmanning timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT jingji timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT longtinglin timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT markparsons timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT andrewkcheung timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT danielwardman timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT chushuangchen timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT suzannejhodgkinson timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT helenbadge timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT vivekpidugun timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney AT timmypham timetoendovascularthrombectomyforacuteischaemicstrokeinlanguageotherthanenglishlotecommunitiesinsouthwesternsydney |