Ictus en pacientes muy mayores. Análisis comparativo entre una unidad de neurología y otros servicios de medicina

Introduction. The aim of this study is to compare the diagnosis, management, clinical course and outcome of the very major patients with acute stroke in our sanitary area. Method. Retrospective collection of data from a hospital-based registry, betwen January 2002 and March 2004, 130 stroke patients aged 84 and older admitted consecutively. We compared the patients admited to the neurology unit (NU) to those admitted to other services (GWs). Demographic analysis, risk factors, morbidity to hospital admission (dementia, cancer, previous stroke and laboratory variables), neurological deficit measured for Canadian Neurological Scale (CNS) score, diagnostic studies, length of stay, outcomes variables (in-hospital mortality, complications developed during hospitalization and Rankin scale at hospital discharge) and need for institutionalization were analyzed. Results. from a total of 130 patients, 44 (34,1%) admitted to NU and 85 (65,9%) to GWs. No difference was seen in demographic analysis, risk factors, morbidity to hospital admission, neurological deficit and outcomes variables. Length of stay was 8,4 days; 5,5 in the NU and 12,87 days among patients in the GWs (p=0,0001). There are significant differences in diagnostic studies in favor to NU (p<0,05). Among the patients admitted into GWs the percentage of institutionalization to the discharge was of 28,8 % opposite to 5,6% in the NU (p=0,006). Conclusions. There are not evidences of age discrimination for access to neurological units for demographic, risk factors, morbidity or neurological deficit. The diagnostic process is more rigorous and less costly in the NU than in the GWs.