Oquendo Bruno, Jarzebowski Witold, Nouhaud Charlotte, Leger Anne, Oasi Christel, Havreng-Thery Charlotte, Lafuente-Lafuente Carmelo, Belmin Joel
Service de Gériatrie à Orientation Cardiovasculaire et Neuropsychogériatrique, APHP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Hôpital Charles Foix, 7 Avenue de la République, 94200, Ivry-sur-Seine, France.
Service de Gériatrie, Hôpital de Bastia, Bastia, France.
Eur Geriatr Med. 2025 Jun 27. doi: 10.1007/s41999-025-01225-9.
To compare the survival of stroke patients over 70 years old managed in the collaborative Stroke Pathway dedicated to the OLD patients (SPOLD) with those referred to conventional rehabilitation wards.
This longitudinal observational retrospective cohort study involved over 70 years old patients referred from the same neurovascular emergency unit in a university hospital in France to a post-stroke geriatric unit within the SPOLD pathway, compared to patients referred to conventional rehabilitation ward during the same period. Initial stroke severity and comorbidities were assessed using the NIHSS score and the Charlson index, respectively. The primary endpoint was 2-year survival, analyzed using Cox models for both the entire cohort and a propensity score-matched cohort to control for referral bias.
The study included 262 patients with a mean age of 84.5 ± 6.7 years, of whom 122 (46.6%) were male. Patients in the SPOLD group (n = 101) had significantly higher age, NIHSS scores, and Charlson indices compared to those in the conventional rehabilitation ward (n = 161). Adjusted mortality was significantly lower in SPOLD patients (OR: 0.525, 95% CI: 0.298 to 0.924, p = 0.025). In the propensity score-matched cohort, mortality was also significantly lower for SPOLD patients (OR: 0.426, 95% CI: 0.212 to 0.857, p = 0.017).
This study suggests that this collaborative organization between a neurovascular emergency unit and a rehabilitation geriatric unit may be associated with a better survival of older patients after stroke.
比较在专门针对老年患者的协作性卒中治疗路径（SPOLD）中接受治疗的70岁以上卒中患者与转诊至传统康复病房的患者的生存率。
这项纵向观察性回顾性队列研究纳入了法国一家大学医院同一神经血管急诊科转诊至SPOLD路径下的卒中后老年病房的70岁以上患者，并与同期转诊至传统康复病房的患者进行比较。分别使用美国国立卫生研究院卒中量表（NIHSS）评分和查尔森指数评估初始卒中严重程度和合并症。主要终点为2年生存率，使用Cox模型对整个队列以及倾向得分匹配队列进行分析，以控制转诊偏倚。
该研究纳入了262例患者，平均年龄为84.5±6.7岁，其中122例（46.6%）为男性。与传统康复病房（n = 161）的患者相比，SPOLD组（n = 101）的患者年龄、NIHSS评分和查尔森指数显著更高。SPOLD组患者的校正死亡率显著更低（OR：0.525，95%CI：0.298至0.924，p = 0.025）。在倾向得分匹配队列中，SPOLD组患者的死亡率也显著更低（OR：0.426，95%CI：0.212至0.857，p = 0.017）。
本研究表明，神经血管急诊科与康复老年病房之间的这种协作组织可能与老年卒中患者更好的生存率相关。
