Stroke in elderly patients: management and prognosis in the ED

Montout, Viviane; Madonna-Py, Beatrice; Josse, Marie-Odile; Ondze, Igor; Arhan, Amandine; Crozier, Sophie; Hausfater, Pierre; Riou, Bruno; Boddaert, Jacques

doi:10.1016/j.ajem.2007.10.023

« Previous Next »American Journal of Emergency Medicine
Volume 26, Issue 7 , Pages 742-749, September 2008

Stroke in elderly patients: management and prognosis in the ED

Viviane Montout, MD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
Beatrice Madonna-Py, MD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
Marie-Odile Josse, MD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
Igor Ondze, MD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
Amandine Arhan, MD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
Sophie Crozier, MD
- Stroke Center, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
Pierre Hausfater, MD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
Bruno Riou, MD, PhD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
Jacques Boddaert, MD, PhD
- Department of Emergency Medicine and Surgery, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
- Geriatric Center, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
- Corresponding author. Centre de gériatrie, et Service d'Accueil des Urgences et service de gériatrie, Groupe Hospitalier Pitié-Salpêtrière, 75013 Paris, France. Tel.: +33 1 42 17 72 49; fax: +33 1 42 17 72 64.

Received 19 June 2007; received in revised form 13 October 2007; accepted 14 October 2007.

Abstract

Purpose

The aim of the study was to analyze the effect of age on management and prognosis of stroke.

Methods

A retrospective study was performed in consecutive patients admitted to an emergency department (ED) with a diagnosis of stroke. Comparison according to age (<75 vs ≥75 years old) was done, with a 1-year follow-up including autonomy and outcome.

Results

In older patients, brain magnetic resonance imaging (6% vs 27%, P < .001) and immediate referral to the stroke unit were less frequent (6% vs 28%, P < .001); median length of stay was longer (11 vs 8 days, P = .007); and in-hospital mortality tended to be higher (12% vs 6%, not significant). After discharge, 1-year mortality was higher (27% vs 14%, P = .004). In a multivariate analysis, severity of stroke, hemorrhagic stroke, and dementia were independent positive predictors of 1-year mortality, whereas age was not.

Conclusion

Despite the fact that age was not an independent predictor when stroke severity was considered, our data suggest differences in the management of elderly compared with younger stroke patients admitted to the ED.