Comparing acute hospital outcomes for people with post-stroke aphasia who do and do not require an interpreter

Figures & data

Table 1. Demographics and characteristics of patients with aphasia by interpreter status after acute stroke.

	Interpreter N=193 (6%)		No Interpreter N=2929 (94%)
Patient characteristics	n	%	n	%
Age, median (Q1, Q3)	78 (70, 85)		78 (69, 86)
Age groupings
<65	32	17	530	18
65–74	40	21	611	21
75–84	72	37	914	31
85+	49	25	874	30
Male^a	86	45	1511	52
Aboriginal or Torres Strait Islander^b	7	4	89	3
Independent prior to stroke*	139	72	2148	73
Living arrangements prior to admission
Home (alone)	24	12	743	25
Home (with others)	151	78	1807	62
Supported accommodation	16	8	357	12
Stroke Risk Factors
History of atrial fibrillation^d	48	28	896	33
History of ischaemic heart disease^d	46	26	735	27
Previous stroke or TIA^c	55	30	908	32
Stroke Type
Haemorrhagic stroke	36	19	397	14
Ischaemic stroke	153	79	2437	83
Undetermined stroke type	4	2	95	3
Severity Indicators on admission
Arm impairment^b	139	73	2055	71
Unable to walk^c	138	73	1933	70
Incontinent in first 72 hours^c	107	56	1528	54
Dysphagia^d	117	61	1645	56
Neglect/inattention^e	60	40	770	44

bold font = p < 0.05; TIA: Transient Ischaemic Attack; *defined as modified Rankin Scale score 0–2

^a<1% missing/unknown data; ^b1-<2% missing/unknown data; ^c2–<5% missing/unknown data; ^d5–<10% missing/unknown data; e 10–<20% missing/unknown data.

Table 2. Ward of admission and adherence to processes of care by interpreter status for people with aphasia after acute stroke.

	Interpreter N=193		No Interpreter N=2929
	n	%	n	%	Χ^2 p value	Adjusted OR^# (95% CI)
Admitted directly to Stroke Unit^a	111	58	1533	52	0.16	0.84 (0.58, 1.20)
Treated in a Stroke Unit at any time	152	79	1978	68	0.001	1.04 (0.66, 1.67)
Time Dependent Therapy
Received intravenous thrombolysis (ischaemic)^e	29	19	49	17	0.49	1.11 (0.71, 1.74)
Received thrombolysis within 60 minutes (ischaemic)	5	17	116	28	0.20	0.48 (0.16, 1.40)
Brain scan within 24 hours of stroke^a	179	93	2694	93	0.92	1.04 (0.57, 1.87)
Nursing and Allied Health
Swallow screen prior to oral intake	134	69	2125	73	0.35	0.90 (0.63, 1.27)
Speech pathology assessment*^d	170	96	2522	93	0.14	1.67 (0.74, 3.77)
Physiotherapy assessment*^d	172	96	2453	90	0.01	2.34 (1.06, 5.19)
Occupational therapy assessment*^e	161	92	2307	89	0.18	1.34 (0.73, 2.46)
Social work assessment*^f	111	71	1423	63	0.045	1.15 (0.75, 1.75)
Dietetics assessment^†f	51	63	721	72	0.09	0.63 (0.36, 1.09)
Mood assessed	34	18	683	23	0.07	0.50 (0.002, 0.73)
Psychology assessment^‡f	1	13	26	14	0.91	1.20 (0.09, 15.97)
Communication and Preparation for discharge
Goals set	170	88	2500	85	0.30	0.99 (0.60, 1.64)
Received information on stroke	108	56	1702	58	0.56	0.97 (0.69, 1.36)
Risk factor advice provided on discharge^d	43	73	621	75	0.67	0.71 (0.34, 1.46)
Care plan developed with team and patient	74	77	974	72	0.24	1.16 (0.63, 2.13)
Discharge summary to primary care physician^d	111	94	1828	96	0.27	0.67 (0.25, 1.77)
Carer needs assessed	29	83	157	61	0.01	2.64 (0.86, 8.04)
Carer training provided	30	86	137	55	0.001	4.83 (1.70, 13.70)
Secondary prevention medications prescribed on discharge^§
Antithrombotics (ischaemic)	61	95	841	99	0.046	0.29 (0.08, 1.05)
Antihypertensives	59	80	722	79	0.67	1.15 (0.61, 2.15)
Lipid lowering (ischaemic)	59	90	734	88	0.52	1.31 (0.55, 3.16)

bold font = p < 0.05; Χ²: chi square; OR: odds ratio; CI: Confidence interval.

^#adjusted for individual hospital variation using random effects logistic regression; *excludes where not required/patient declined; ^†if identified dysphagia, hydration or nutrition problem; ^‡if a mood impairment present; ^§if not contraindicated, futile, and ischaemic stroke or transient ischaemic attack.

^a<1% missing/unknown data; ^b1-<2% missing/unknown data; ^c2–<5% missing/unknown data; ^d5–<10% missing/unknown data; ^e10–<20% missing/unknown data; ^f20–30% missing data

Figure 1. Hospital complications in people with aphasia by interpreter status.

No data missing across all complications.

*p < 0.05

Table 3. Hospital outcomes by interpreter status.

	Interpreter		No Interpreter
	n	%	n	%	Χ^2 p value	Adjusted OR^# (95% CI)
Outcome
Death	41	21	542	19	0.34	1.09 (0.71, 1.68)
Independent on discharge (mRS score 0–2)	38	20	753	26	0.06	0.56 (0.34, 0.92)
One or more hospital complications	94	49	1310	45	0.28	1.15 (0.82, 1.61)
Discharge Destination
Private residence^¶	62	41	876	37	0.31	1.19 (0.80, 1.77)
New residential care	10	7	87	4	0.07	1.27 (0.58, 2.82)
Inpatient rehabilitation	50	33	854	36	0.47	0.87 (0.58, 1.30)
Other hospital	17	11	349	15	0.24	0.86 (0.47, 1.59)
Other^||	13	9	221	9	0.77	1.16 (0.59, 2.28)
	Interpreter		No Interpreter
Length of Stay (days)	median	(Q1, Q3)	median	(Q1, Q3)	Coefficient^# (95% CI)
Including deaths	8	4, 17	6	3, 11	1.3 (0.11, 2.56)
Excluding deaths	9	4, 18	6	3, 11	2 (0.05, 3.50)

bold font = p < 0.05; Χ2: chi square; OR: odds ratio; CI: Confidence interval; mRS: Modified Rankin Scale.

*adjusted for age, sex, pre-morbid independence, hospital location, stroke type, and stroke severity indicators on admission – inability to walk, arm impairment, and incontinence; ^¶including return to residential care; ^||including to other ward/unit, left against medical advice, transitional care.

<1% missing/unknown data.