***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective : To study the short and long term differences in outcome between patients ⩾80 years of age and those ⩽79 years of age who received intravenous recombinant tissue plasminogen activator ( iv rt-PA ) for acute stroke within the first 3 hours of symptom onset . Methods : We studied consecutive patients treated with iv rt-PA for acute stroke , with prospect i ve follow up of up to 3 years . Outcome measures included National Institutes of Health Stroke Scale ( NIHSS ) score , Barthel Index ( BI ) , modified Rankin score ( MRS ) , and stroke mortality . Patients were split into two groups : younger ( ⩽79 years ) and older ( ⩾80 years ) . Results : There were 65 patients in the younger cohort and 31 patients in the older . Older patients were more likely to present with more severe baseline stroke ( p = 0.04 ; odds ratio ( OR ) 3.04 ; 95 % confidence interval ( CI ) 1.03 to 8.98 ) . Stroke mortality at 90 days was 10.8 % in the younger and 32.3 % in the older cohort ( p = 0.01 ) . At 90 days ’ follow up , patients in the older cohort with more severe stroke ( NIHSS score ⩾11 ) were nearly 10 times more likely to have poor outcome compared with their younger counterparts presenting with severe stroke ( p = 0.001 ; OR = 10.36 ; 95 % CI 2.16 to 49.20 ) . Baseline stroke severity and age were the only independent and equal predictors for stroke outcome . No threshold was found for age or baseline stroke severity predicting outcome . Conclusion : Older patients presenting with more severe baseline stroke are much less likely to benefit from iv rt-PA as compared with their younger counterparts Despite the frequent use of clinical rating scales in multicenter therapeutic stroke trials , no generally acceptable method exists to train and certify investigators to use the instrument consistently . We desired to train investigators to use the National Institutes of Health Stroke Scale in a study of acute stroke therapy so that all examiners rated patients comparably . Methods We devised a two-camera videotape method that optimizes the visual presentation of examination findings . We then measured the effectiveness of the training by asking each investigator to evaluate a set of 11 patients , also on videotape .  We tabulated the evaluations , devised a scoring system , and calculated measures of interobserver agreement among the participants in this study . Results We trained and certified 162 investigators . We found moderate to excellent agreement on most Stroke Scale items ( unweighted K>0.60 ) . TWO items , facial paresis and ataxia , exhibited poor agreement ( unweighted K<0.40 ) and should be revised in future editions of the scale . Performance improved with video training compared with previous studies . Inclusion of the motor rating of the unaffected limbs in the total score did not affect reliability . Conclusions Video training and certification is a practical and effective method to st and ardize the use of examination scales . Two cameras must be used during the taping of patients to accurately present the clinical findings . This method is easily adapted to any study in which a large number of investigators will be enrolling patients at multiple clinical centers Introduction . Systemic thrombolysis with intravenous recombinant tissue plasminogen activator ( rtPA ) for acute ischemic stroke had been licensed for patients up to 75 years in age in many European countries and was recently extended to 80 years . This age restriction results from the potential higher risk of cerebral bleeding in the elderly . The major rtPA trials included only 42 patients above 80 years showing a potential benefit from treatment . Further data is still rare . Methods . Using our stroke data base we identified all patients beyond 75 years with middle cerebral artery ischemia treated with intravenous rtPA in our stroke unit from 02/1999 until 07/2004 . Clinical course and outcome until day 5 in addition to mortality after 3 and 6 months were analysed . Results . Twenty-nine patients ( 80.8 ± 4 years , 16 of them over 80 years old ) met the inclusion criteria representing 21.2 % of those receiving thrombolytic therapy .  The median NIH-SS score on admission was 14 points . On day 5 after thrombolysis , 13/29 showed a good recovery ( NIH-SS improvement ≥4 pts ) . The remaining exhibited only small or no benefit ( n = 11 ) , deterioration ( n = 3 ) or died ( n = 2 ) . A total of 3/29 patients developed non-symptomatic parenchymal hemorrhage or hemorrhagic transformation . One patient died due to space-occupying cerebral hemorrhage . Extracerebral bleeding was found in 3/29 requiring substitution in one . One other died for primary cardiac reasons . Median NIH-SS on day 5 was 10 points . Mortality after 3 and 6 months was 20.7 % . We did not find factors predicting clinical outcome . Most importantly , there was no significant difference regarding outcome in patients 76–80 vs. 81–87 years old . Discussion . Intravenous rtPA result ed in good neurological in-hospital outcome in almost 45 % and six-months survival of almost 80 % of the patients beyond 75 years . In 10.3 % non-symptomatic and in 3.4 % symptomatic cerebral bleeding was found . Thus , seniors beyond 75 and even beyond 80 years in good medical condition may benefit from systemic treatment with rtPA . Prospect i ve studies are needed to clarify which part of the senior population might be most eligible for systemic thrombolysis Background and Purpose — Only a single study has demonstrated beneficial effects of intravenous tissue plasminogen activator ( tPA ) in stroke patients . Methods — We evaluated the clinical outcomes of the 61 patients enrolled in the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke ( ATLANTIS ) study who were r and omized to receive intravenous tPA or placebo within 3 hours of symptom onset . Results — Despite a significant increase in the rate of symptomatic intracranial hemorrhage , tPA-treated patients were more likely to have a very favorable outcome ( score of ≤1 ) on the National Institutes of Health Stroke Scale at 90 days ( P = 0.01 ) . Conclusions — These data support current recommendations to administer intravenous tPA to eligible ischemic stroke patients who can be treated within 3 hours of symptom onset This data bank-based , multicenter study compared all stroke patients with IV tissue plasminogen activator aged ≥80 years ( n = 38 ) and those < 80 years old ( n = 287 ) . Three-month mortality was higher in older patients .  Favorable outcome ( modified Rankin scale ≤1 ) and intracranial hemorrhage ( asymptomatic/symptomatic/fatal ) were similarly frequent in both groups . Logistic regression showed that stroke severity , time to thrombolysis , glucose level , and history of coronary heart disease independently predicted outcome , whereas age did not Abstract . Objective : Disability and mortality represent the most relevant clinical outcome after acute ischemic stroke . However , vali date d and comprehensive prognostic models for recovery have not been developed . An accurate model including all previously suggested independent outcome predictors could improve the design and analysis of clinical trials . We therefore developed prognostic models for functional dependence and death after 100 days in a large cohort of stroke patients . Methods : From the German Stroke Data base , 1754 prospect ively collected records of patients with acute ischemic stroke were used for the development of prognostic models . Intubated patients and patients with low functional status before stroke were excluded . Functional independence was defined as a Barthel Index ≥95 after 100 days . Prognostic factors assessable within 72 hours after admission were identified by a systematic literature review . The final models of binary logistic regression analyses were internally vali date d and calibrated . Results : The result ing cross-vali date d and calibrated models correctly classified more than 80 % of the patients and yielded the following prognostic factors for functional independence : Age , right and left arm paresis at admission , NIH-Stroke Scale at admission , Rankin Scale 48–72 hours later , gender , prior stroke , diabetes , fever , lenticulostriate infa rct ion , neurological complications . The following variables were identified as prognostic factors for death : Age , NIH-Stroke Scale at admission , and fever . Conclusions : Our work gives an important insight into prognostic factors after acute ischemic stroke and presents predictive models with high prognostic accuracy . Together with a prospect i ve validation study , currently underway , we hence hope to improve the prediction of functional outcome after ischemic stroke CONTEXT Data are limited regarding the risks and benefits of thrombolytic therapy for acute ischemic stroke outside of clinical trials . OBJECTIVE To investigate predictors of in-hospital mortality in patients with ischemic stroke treated with intravenous tissue plasminogen activator ( tPA )  within a pooled analysis of large German stroke registers . DESIGN AND SETTING Prospect i ve , observational cohort study conducted at 225 community and academic hospitals throughout Germany cooperating within the German Stroke Registers Study Group . PATIENTS A total of 1658 patients with acute ischemic stroke who were admitted to study hospitals between 2000 and 2002 and were treated with tPA .  MAIN OUTCOME MEASURE In-hospital mortality . RESULTS One hundred sixty-six patients ( 10 % ) who received tPA  died during hospitalization , with 67.5 % of these deaths occurring within 7 days . Factors predicting in-hospital death after tPA use were older age ( for each 10-year increment in age , adjusted odds ratio [ OR ] , 1.6 ; 95 % confidence interval [ CI ] , 1.3 - 1.9 ) and altered level of consciousness ( adjusted OR , 3.4 ; 95 % CI , 2.4 - 4.7 ) . The overall rate of symptomatic intracranial hemorrhage was 7.1 % and increased with age . One or more serious complications was observed in 27.2 % of all patients and in 83.9 % of patients who died after tPA treatment . An inverse relation between the number of patients treated with tPA  in the respective hospital and the risk of in-hospital death was observed ( adjusted OR , 0.97 ; 95 % CI , 0.96 - 0.99 for each additional patient treated with tPA per year ) . CONCLUSION In patients with ischemic stroke who are treated with tPA  , disturbances of consciousness and increasing age are associated with increased in-hospital mortality BACKGROUND Acute ischaemic stroke is common in older people . There is one licensed acute treatment , intravenous recombinant tissue plasminogen activator , but little information is available on its safety in over 80 year olds . DESIGN Review of prospect ively collected data on 62 consecutive patients , aged 80 years and over , treated with recombinant tissue plasminogen activator in a tertiary centre . METHODS Admission demographic data , clinical and CT stroke severity , symptomatic haemorrhage rate and other complications were compared between patients who were dead at 3 months and those who survived . Discharge location and functional scores outcome were review ed . The results were compared to those of other studies . RESULTS The in-hospital death rate was 24.2 % and 3 month mortality 32.8 % . Patients that died had higher stroke severity scores at presentation ( NIHSS 20 versus 16 , P = 0.04 ) . Six patients ( 9.7 % ) suffered symptomatic intracranial haemorrhage ( SICH ) , three were classified as fatal ( 4.8 % ) . SICH was significantly associated with death by 3 months ( P = 0.02 ) . There were no other serious bleeding complications . The SICH rate is similar to that from other thrombolytic studies and the mortality rate is similar to the natural history of stroke in older population s. CONCLUSION Older patients have high mortality and morbidity from stroke . Older patients should not be excluded from recombinant tissue plasminogen activator treatment on the basis of age alone BACKGROUND Thrombolytic therapy for acute ischemic stroke has been approached cautiously because there were high rates of intracerebral hemorrhage in early clinical trials . We performed a r and omized , double-blind trial of intravenous recombinant tissue plasminogen activator ( t-PA ) for ischemic stroke after recent pilot studies suggested that t-PA was beneficial when treatment was begun within three hours of the onset of stroke . METHODS The trial had two parts . Part 1 ( in which 291 patients were enrolled ) tested whether t-PA had clinical activity , as indicated by an improvement of 4 points over base-line values in the score of the National Institutes of Health stroke scale ( NIHSS ) or the resolution of the neurologic deficit within 24 hours of the onset of stroke . Part 2 ( in which 333 patients were enrolled ) used a global test statistic to assess clinical outcome at three months , according to scores on the Barthel index , modified Rankin scale , Glasgow outcome scale , and NIHSS : RESULTS In part 1 , there was no significant difference between the group given t-PA and that given placebo in the percentages of patients with neurologic improvement at 24 hours , although a benefit was observed for the t-PA group at three months for all four outcome measures . In part 2 , the long-term clinical benefit of t-PA predicted by the results of part 1 was confirmed ( global 
    Output:
    
intravenous rtPA-treated stroke patients of > /=80 years of age have a less favourable outcome than younger ones .
Imbalances in predictive baseline variables to the disadvantage of the older patients may contribute to this finding .
Compared with the younger cohort , rtPA-treated stroke patients aged > /=80 years do not seem exceedingly prone to sICH .
Thus , there is scope for benefit from thrombolysis for the older age group .