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Stroke in elderly patients: management and prognosis in the ED

  • Viviane Montout
    Affiliations
    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
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  • Beatrice Madonna-Py
    Affiliations
    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
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  • Marie-Odile Josse
    Affiliations
    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
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  • Igor Ondze
    Affiliations
    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
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  • Amandine Arhan
    Affiliations
    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
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  • Sophie Crozier
    Affiliations
    Stroke Center, Centre Hospitalo-Universitaire (CHU) Pitié-Salpêtrière, Assistance-Publique Hôpitaux de Paris (AP-HP), Université Pierre et Marie Curie-Paris 6, Paris, France
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  • Pierre Hausfater
    Affiliations
    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
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  • Bruno Riou
    Affiliations
    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
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  • Jacques Boddaert
    Correspondence
    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.
    Affiliations
    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
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      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.
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