Age effect on the prediction of risk of prolonged length hospital stay in older patients visiting the emergency department: results from a large prospective geriatric cohort study.

BACKGROUND: With the rapid growth of elderly patients visiting the Emergency Department (ED), it is expected that there will be even more hospitalisations following ED visits in the future. The aim of this study was to examine the age effect on the performance criteria of the 10-item brief geriatric assessment (BGA) for the prolonged length of hospital stay (LHS) using artificial neural networks (ANNs) analysis. METHODS: Based on an observational prospective cohort study, 1117 older patients (i.e., aged ≥ 65 years) ED users were admitted to acute care wards in a University Hospital (France) were recruited. The 10-items of BGA were recorded during the ED visit and prior to discharge to acute care wards. The top third of LHS (i.e., ≥ 13 days) defined the prolonged LHS. Analysis was successively performed on participants categorized in 4 age groups: aged ≥ 70, ≥ 75, ≥ 80 and ≥ 85 years. Performance criteria of 10-item BGA for the prolonged LHS were sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], likelihood ratios [LR], area under receiver operating characteristic curve [AUROC]). The ANNs analysis method was conducted using the modified multilayer perceptron (MLP). RESULTS: Values of criteria performance were high (sensitivity> 89%, specificity≥ 96%, PPV > 87%, NPV > 96%, LR+ > 22; LR- ≤ 0.1 and AUROC> 93), regardless of the age group. CONCLUSIONS: Age effect on the performance criteria of the 10-item BGA for the prediction of prolonged LHS using MLP was minimal with a good balance between criteria, suggesting that this tool may be used as a screening as well as a predictive tool for prolonged LHS.

[Aphasia caused by isolated lesion of the semi-ovale centre: contribution of the measurement of cerebral blood flow]. / Aphasie par lésion isolée du centre semi-ovale: approt de la mesure du débit sanguin cérébral.

Sudden onset stroke occurred in a right-handed vietnamese woman speaking, reading and writing french fluently. When first seen in our department, the patient had mild right facial paresis and non fluent atypical aphasia. CT scan and MRI showed a left subcortical infarct in the superficial territory of the middle cerebral artery; only white matter of the semiovale centre was involved. Neurological examination revealed linguistic impairment resembling transcortical motor aphasia, with unusual stuttering, hypophonia, occasional semantic paraphasias and phonological reading and writing abnormalities. Non verbal cognitive function, gestural and buccofacial praxes were normal. Cerebral blood flow study by SPECT was consistent with left sylvian functional deactivation.

[Right hemiplegia and spatial neglect with apraxia and agraphia without aphasia in a right-handed patient]. / Hémiplégie droite et négligence avec apraxie et agraphie sans aphasie chez une patiente droitière.

A 65 year-old right-handed woman was admitted after the sudden onset of a right dense hemiplegia. C.T. showed a large left infarction in the middle cerebral artery territory. There was a slight anosognosia and neglect of the right space without confusion. She had aprosodia but no aphasia. On the other hand, there was a severe apraxia and all the components of Gerstmann's syndrome were present. This suggests an unusual sattering of hemispheric functional dominances.