Diagnostic Workup in Geriatric Patients with Ischemic Stroke: A Retrospective Observational Study from a Specialized Geriatrics Unit
Naomi Nazareth Becerra Aguiar1, Diego de Jesús Gómez López2, Alejandra Stephanie Hernandez Montoya4, Gabriela Asencio del Real2, Jose Luis Ruiz Sandoval3, Amado Jimenez Ruiz3
1Faculty of Medicine, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, 2Geriatrics Department, 3Neurology Department, Hospital Civil de Guadalajara Fray Antonio Alcalde, 4Faculty of Medicine, Centro Universitario del Sur, Universidad de Guadalajara
Objective:
To detail the diagnostic workup for ischemic stroke (IS) within the Geriatrics Department of Hospital Civil Fray Antonio Alcalde (HCFAA).
Background:
The Mexican geriatric population has grown significantly, leading to increased mortality rates, with IS identified as a primary cause. A thorough diagnostic evaluation is vital for accurately classifying etiologies, identifying risk factors, and guiding therapeutic interventions and prevention strategies.
Design/Methods:
We conducted a retrospective analysis of patients aged ≥65 years diagnosed with IS in the Geriatric Unit of HCFAA, an academic tertiary care center in Guadalajara, Mexico, from January 2022 to July 2023. We employed descriptive statistics to examine the diagnostic approach, interventions, and short-term outcomes.
Results:
We analyzed 168 patients, mean age of 75.9 years. The most prevalent risk factors were hypertension, diabetes, and atrial fibrillation. The average time from symptom onset to emergency department arrival was 22.3 ± 37.1 hours, with a registration-to-admission time of 16.7 ± 10.5 hours. The median NIHSS score was 12.5 ± 7.7.
All patients underwent electrocardiography, head CT was performed in 98.8%, echocardiography in 51.8%, MRI in 38.7%, carotid ultrasonography in 32.1%, 24-hour Holter monitoring in 30.4%, head CTA in 5.4%, and head MRA in 4.8%. IS were supratentorial in 85.1% and infratentorial in 14.9%. TOAST classification identified large artery atherosclerosis (13.1%), cardioembolism (25.6%), lacunar (3%), undetermined etiology (13.7%), and incomplete evaluation in 44.6%.
Regarding therapeutic interventions, 8.3% received tPA and 1.2% underwent thrombectomy. In-hospital mortality was 25.6%, while 30-day mortality was 7.1%.
Conclusions:
Our findings reveal significant deficiencies and incomplete diagnostic workup in a substantial proportion of patients. Early stroke recognition and timely interventions are crucial for improving outcomes. Delays in seeking care highlight the need for public education and streamlined treatment protocols. Comprehensive diagnostic evaluations can reduce undetermined causes, while specialized care pathways are essential to lowering in-hospital mortality in the elderly population.
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