Exploring the association between undiagnosed prior stroke and short-term mortality among older adults who have fallen.

Abstract

Objectives: Older adults commonly present to the emergency department after a fall. Head imaging is frequently ordered for these patients. Occasionally, head imaging finds evidence of chronic stroke when there is no clinical history of stroke. The clinical implications of undiagnosed prior stroke are unknown. Our objective was to explore the association between undiagnosed prior stroke and short-term mortality after a fall.

Methods: This was a secondary analysis of a prospective multicenter cohort study enrolling patients ≥ 65 years presenting to the emergency department after a fall. Patients were included if they had a head CT scan during their visit, and their vital status was known at 42 days. We used a logistic regression model to examine the relationship between previously undiagnosed prior stroke and death within 42 days. The model adjusted for age, sex, use of antiplatelet/anticoagulant medications, and Clinical Frailty Scale score.

Results: Among 4308 enrolled patients, 2698 had a head CT scan at the index visit, of whom 2307 were known to be alive or dead at 42 days. The median age was 84 (IQR 77-89) years, and 62% were female. At 42 days, 131 patients (6%) had died. There was no association between death at 42 days and undiagnosed prior stroke (aOR 0.84, 95% CI: 0.47-1.49). Male sex (aOR 1.64, 95% CI: 1.14-2.37) and Clinical Frailty Scale score (aOR 1.49, 95% CI: 1.31-1.70) were associated with death.

Conclusions: Previously undiagnosed stroke was not associated with short-term survival in older adults after a fall and should not be considered an indicator of worse short-term outcome in the clinical setting.