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Abstract Details

The Oldest Bleeds in the Oldest State: Hemorrhagic Stroke in the Nonagenarian Population
Cerebrovascular Disease and Interventional Neurology
P13 - Poster Session 13 (5:30 PM-6:30 PM)
4-001
To evaluate the characteristics, mortality, and morbidity in nonagenarians presenting with acute hemorrhagic stroke (AHS)
Little is known about the outcomes of hemorrhagic strokes in the extreme elderly, making discussion of potential outcomes problematic. We reviewed our experience admitting nonagenarians with AHS to the only comprehensive stroke center in Maine.
We performed a retrospective observational study by convenience sampling of all patients ≥90 years presenting to Maine Medical Center with AHS (nontraumatic intracerebral hemorrhage [ICH] or subarachnoid hemorrhage [SAH]) from 2010-2018. Simple descriptive statistics described patient demographics, risk factors, stroke characteristics, and outcomes.
Forty-four AHS patients (68% female, mean age 91.6, ±1.6) were identified, including 26 (59%) with ICH and 18 (41%) with SAH. This represented 0.63% of all stroke admissions and 2.5% of AHS overall. This was the first stroke for 31 (70%) of the patients. On admission, 20 patients (45.5%) were “full code” and on discharge 15 (34%) remained “full code.” One changed code status to “tailored code,” one to “DNR-CMO,” and three to “DNR.” Four patients (9%) were admitted with anticoagulant-associated (warfarin) ICH, with mean INR of 2 (±0.7). Five patients (11%) underwent mechanical ventilation, with four (9%) receiving tracheostomy placement. Six patients (14%) underwent gastrostomy tube placement prior to discharge. Median length of stay was 3 days (IQR 2, 4). The mortality rate in nonagenarians was 48% compared to 18% in the general AHS population (P<0.001).
Among patients with hemorrhagic stroke admitted to Maine Medical Center, one in forty were ≥90 years. These patients suffered higher mortality than those aged 18-89. More research is needed to evaluate how disease characteristics and treatments in the extreme elderly correlate with outcomes to help guide goals of care discussions and societal resource utilization.
Authors/Disclosures
Robert G. Michaud, Jr.
PRESENTER 		No disclosure on file
Michael P. Stanley, MD (Tufts Medical Center) Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a Consultant for Roon. Dr. Stanley has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Annals of Neurology. Dr. Stanley has stock in Roon. Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a writer at large with WBUR/Cognoscenti . Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a Poet with Writing the Land. Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a writer at large with Psyche. Dr. Stanley has received personal compensation in the range of $0-$499 for serving as a Writer at large with Wall Street Journal.
No disclosure on file
David Seder, MD (Maine Medical Center) No disclosure on file