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Abstract W P198: Older Stroke Patients Get Fewer Diagnostic Tests


 Introduction:
 Embolic stroke of undetermined source (ESUS), or non-lacunar cryptogenic stroke, accounts for up to one-third of all strokes. As it is a diagnosis of exclusion of other stroke etiologies, an incomplete evaluation of stroke may result in an unclear diagnosis.
 
 
 Hypothesis:
 Our objective was to determine if older patients are at risk for receiving incomplete diagnostic evaluations in an international cohort study.
 
 
 Methods:
 The ESUS Global Registry was a retrospective cohort of consecutive stroke patients evaluated at 20 stroke centers in 20 countries. Diagnostic evaluation was considered complete if the patient had, at a minimum, brain CT or MRI, carotid imaging, ECG, ≥24 hours of cardiac rhythm monitoring, and echocardiography. Patients were classified as having experienced an ESUS if brain imaging confirmed a non-lacunar infarction and no stroke etiology was determined after complete evaluation. Completeness of evaluation was compared between patients ≥75 vs. <75 years old.
 
 
 Results:
 The registry included 2,090 patients with recent ischemic stroke during 2013-2014. Forty-three percent of patients ≥75 years old had a complete evaluation compared to 51% of patients <75 years (p<0.001). Fewer patients ≥75 underwent echocardiography (64% vs. 74%, p<0.001) and carotid imaging (85% vs. 91%, p<0.001). Three hundred seventy-eight patients (18%) had a complete evaluation and were diagnosed with ESUS. Among ESUS patients, those ≥75 were more likely to have only transthoracic echocardiography (84% vs. 65%, p<0.001), only carotid ultrasound rather than any other carotid imaging modality (55% vs. 37%, p<0.001), and no intracranial vessel imaging (22% vs. 12%, p=0.011).
 
 
 Conclusions:
 Older patients in this international cohort were more likely to have an incomplete etiologic evaluation for stroke, despite advanced age being well established as an independent risk factor for recurrent stroke. Further investigations are warranted to explore the potential bias in age-associated stroke evaluation completeness.
