Organized inpatient (stroke unit) care in very old patients.
OBJECTIVE
It is unclear whether very old patients benefit from organized inpatient (stroke unit) care. The aim of this work was to compare the clinical outcome of patients with first-ever ischemic stroke aged either >or=80 or <80 years who were treated conservatively (without cerebral revascularization) in a university-based stroke unit.


METHODS
We included 147 (11%) patients >or=80 years and 1241 (89%) patients, <80 years. All patients underwent clinical examination, blood tests, electrocardiography (ECG), brain imaging and cerebrovascular ultrasound. Additional investigations were done at the discretion of the treating physician. The modified Rankin scale (mRS) score was used to assess the 3-month outcome (favorable: mRS, 0-1; poor: mRS, 2-6; death of any cause).


RESULTS
Stroke severity did not differ between both groups [median National Institutes of Health Stroke Scale (NIHSS) score, 4]. Younger patients underwent magnetic resonance (MR) imaging of the brain, MR and catheter angiography and echocardiography (p<0.001) more frequently, whereas older patients underwent computed tomography of the brain and 24-hour ECG (p<0.001) more frequently. Stroke prevention included clopidogrel (p<0.001) and heparin (p=0.047) more often in older patients and aspirin (p=0.016) in younger patients. Recurrent ischemic events were similarly frequent in old (7%) and young (5%) patients. Favorable outcome was equally prevalent in old (71%) and young (76%) patients, whereas mortality was higher in older patients (7 and 3%, p=0.007). Admission NIHSS score >or=12 was the only independent predictor of unfavorable outcome (odds ratio, 19.6; 95% confidence interval, 9.7-39.6; p<0.001).


CONCLUSIONS
Our work provides further evidence that also the oldest patients may benefit from conservative stroke unit care.
Nedeltchev
Krassen
K
University Hospital of Bern, Bern, Switzerland. krassen.nedeltchev@triemli.stzh.ch.ch
Baumann
Christian
C
Haefeli
Tobias
T
Georgiadis
Dimitrios
D
Arnold
Marcel
M
Baumgartner
Ralf W
RW
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000925:Anticoagulants / Q000627:therapeutic use; D015984:Causality; D003952:Diagnostic Imaging / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data* / Q000639:trends*; D020767:Intracranial Thrombosis / Q000175:diagnosis* / Q000188:drug therapy* / Q000451:nursing; D008297:Male; D009026:Mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D020521:Stroke / Q000175:diagnosis* / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors