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Guidelines for optimal speed in treatment were established by the National Institute for Neurological Disorders and Stroke (NINDS) Study Group in 1997. The recommendations suggest an initial physician evaluation within 10 minutes of ED arrival, noncontrast CT scan within 25 minutes, radiologist interpretation within 45 minutes, and the administration of thrombolytics, if appropriate, within 1 hour [68]. Such a stringent timeline is only feasible with firm commitment from the departments of emergency medicine, radiology, and neurology within a given institution.

J Am Geriatr Soc 1996;44:954–8. [44] Smith TJ, Desch CE, Hackney MK, et al. How long does it take to get a ‘‘do not resuscitate’’ order? J Palliat Care 1997;13:5–8. [45] Marco CA. Ethical issues of resuscitation. Emerg Med Clin North Am 1999;17:527–38. [46] Hamel MB, Lynn J, Teno JM, et al. Age-related differences in care preferences, treatment decisions, and clinical outcomes of seriously ill hospitalized adults: lessons from SUPPORT. J Am Geriatr Soc 2000;48:S176–82. [47] Ramos T, Reagan JE. ‘‘No’’ when the family says ‘‘go’’: resisting families’ requests for futile CPR.

3) and treatable by surgical intervention. Practitioners should seek a history of chronic SDH in such patients, because recurrence rates vary from 9% to 26% [41]. Spinal injury Studies on cervical spine trauma show that elderly patients have different predominant mechanisms and patterns of injury. Older patients are more likely to be injured in falls and have increased likelihood of upper cervical injuries, particularly of the odontoid. Lomoschitz and colleagues conducted a retrospective analysis of 149 patients older than the age of 65 years with a total of 225 cervical spine injuries.

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