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To analyse the factors influencing the time of admission of patients presenting an acute ischaemic stroke (AIS) to the emergency department.Between May 2006 and July 2007, all patients with suspected stroke admitted to the emergency department were included. Patients' characteristics and the nature and timing of the events following symptom detection were recorded in the emergency department. The symptoms observed, the person telephoning for help, the person or establishment contacted, the measures implemented (attendance of a physician, medical or paramedical intervention) and the means of transport to the hospital were noted. The overall population was analysed descriptively and patients admitted within 3 hours of symptom onset (group I) were compared with those admitted after a longer interval (group II). The final diagnosis of AIS was confirmed on patient discharge. The results were expressed as the mean (± SD) or median (interquartile range), Mann-Whitney and Chi(2) tests being used to analyse differences between the two groups (threshold of statistical significance: P0.05).Among the 678 patients admitted with suspected stroke, 536 were diagnosed as having experienced an AIS, 65 a haemorrhagic stroke, 3 a cerebral venous thrombosis and 74 an event other than an acute neurovascular event. The results therefore concern 536 patients (median age: 75 years), of whom 166 (31%, group I) were admitted within 3 hours of symptom onset and 370 after a longer interval (group II). The median time between symptom onset and the call for help was 15 min (1-26) in group I and 300 min (60-960) in group II (P0.0001). The median times to intervention of a physician (the patient's regular general practitioner, the physician on duty, or the SMUR [Mobile Emergency and Resuscitation Service] physician) ranged from 10 to 60 min. Median transport times ranged from 30 to 120 min depending on the type of transport employed. The two groups differed significantly with regard to intervention of a physician before admission to the emergency department (40% of patients in group I vs. 72% in group II, P0.0001), initial call to the emergency medical call centre ("15" in France) (42% vs. 17%, P0.001), presence of a relative or other person at the time of functional symptom onset (58% vs. 39%, P0.01), and immediate transport to hospital without medical intervention (49 vs. 11%). Finally, irrespective of the time to hospital admission, 12% of the patients studied were eligible for intravenous thrombolysis.In the event of a suspected stroke, these results favour contacting the emergency medical call centre and immediate transfer of the patient to an appropriate hospital establishment without waiting for prior medical intervention.

The objective of this study was to assess the utility of determining serum cardiac troponin I (TcI) levels in the elderly.During the nine-month study period, all patients older than 70 years admitted to the emergency department presenting rhabdomyolysis (defined by creatine kinase500 IU/L) were included in this prospective descriptive study, except for those with acute coronary syndrome or pulmonary embolism. Patients were classified into two groups according to their serum TcI level:0.15 oror=0. 15 ng/mL. The groups were compared for clinical, laboratory and treatment variables at inclusion and for mortality at six months.The study included 67 patients: 30 in the group with TcI0.15 ng/mL group and 37 in the other group. Clinical and laboratory indicators were similar in the two groups. In contrast, significantly more patients in the TcI0.15 ng/mL group had been treated with a curative dose of heparin (14 versus 2, p=0.01). This difference between the two groups was noted in both the emergency department and other hospital units. Serum TcI levels were not correlated with creatine kinase levels. Concordance between emergency department diagnosis and discharge diagnosis was 95%. No patient was discharged with a diagnosis of acute coronary syndrome; one patient, with a serum TcI levelor=0.15 ng/mL, was diagnosed with a pulmonary embolism. Fewer than half the patients underwent cardiac ultrasonography. Segmental hypokinesia was observed in only a few cases (6% in the TcI0. 15 ng/mL group versus 8% in the other group). Mortality at six months was higher among patients with an elevated serum TcI level, but the difference was not significant (23% versus 8%, p=0.07).This study indicated a trend toward higher mortality among patients with elevated serum TcI levels, although the factors underlying these increased concentrations remain unclear.

The incidence of drug-related adverse events increases with age. In approximately 20% of cases, these events necessitate hospitalization. By taking into account the physiological changes associated with aging when prescribing drugs, physicians can prevent some of these events. The objective of this study was to analyze the prescriptions written by general practitioners for elderly patients admitted to the emergency department in relation to the patient's creatinine clearance.Of 968 consecutive patients older than 70 years, 419 underwent a plasma creatinine assay on admission and were included in this study. Creatinine clearance was calculated with Cockcroft's formula. The patients were classified into two groups according to creatinine clearance:30 mL/min (group I) andor=30 mL/min (group II).Creatinine clearance was30 mL/min in 84 of the 419 patients (group I) andor=30 mL/min in 335 (group II). Mean age was significantly higher in group I than in group II (87 +/- 6 vs 81 +/- 6 years, p0.001), as was mean plasma creatinine concentration (113 +/- 23 vs 83 +/- 19 mmol/L, p0.001), while mean weight was significantly lower (57 +/- 10 vs 69 +/- 13 kg, p0.001. In group I, 82 drugs with precautions concerning renal function had been prescribed for 69 (82%) patients, and in group II, 331 such drugs for 174 (52%) patients. Of the 82 drugs prescribed in group I that required precaution, 47 (57%) were contraindicated or prescribed at an inappropriate dose in view of the creatinine clearance. Irrespective of pharmacokinetic parameters, the mean number of drugs taken per patient was 5 +/- 2 in group I and 6 +/-2 in group II.In prescribing drugs for elderly patients, especially those whose weight is low, careful attention should be paid to renal function.