ArticleNeurocritical care2018
Factors Associated with the Outcome of Very Elderly Patients with Large Hemispheric Infarction Treated with Medical Management Only.
Article in Neurocritical care, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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1 citing paper in PubMed.
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3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundLarge ischemic stroke in the very elderly population is presumed to invariably carry a poor prognosis and clinicians may refrain from continuing intensive care. Many elderly patients are not surgical candidates, and there is a paucity of data outlining the real-world outcomes of continued medical management. Our objective is to identify the factors associated with the outcome of very elderly patients with large hemispheric infarction (LHI) treated with medical management alone.
methodsWe performed a retrospective review of all consecutive adults ≥ 70 years of age with LHI identified from a single center stroke registry between 2012 and 2016. Mean volume of infarction was calculated using the ABC/2 method.
resultsOf a total of 2335 patients, 71 (mean age 81 ± 7 years,) met inclusion criteria. Forty-one were women (58%). Mean admission National Institute of Health Stroke Score (NIHSS) was 21 ± 6. Intravenous tPA was administered in 30 (42%) and 9 (13%) patients underwent thrombectomy. Mean infarct volume was 175 ± 75 cc. Twenty-seven patients (38%) survived to hospital discharge; 6 (9%) eventually went home (albeit with mRS 4) and one (1%) went to assisted living. Multivariate logistic regression analysis found that admission NIHSS ≥ 20 (p = 0.0007) and mechanical ventilation within 48 h of admission (p = 0.0396) were independently associated with poor outcome.
conclusionTen percent of medically managed patients (≥ 70 years of age) with LHI can go home or to assisted living, but with a mRS of 4. Whether this is an acceptable outcome must be individualized on a case-by-case basis; however, poor prognosis should not be automatically presumed solely based on the combination of older age and a large stroke.
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