Acute stroke has a high morbidity and mortality in elderly population. Baseline confounding illnesses, initial clinical examination, and basic laboratory tests may impact prognostics. In this study, we aimed to establish a model for predicting in-hospital mortality based on clinical data available within 12 hours of hospital admission in elderly (≥ 65 age) patients who experienced stroke. Baseline medical problems, clinical severity, and basic laboratory tests available within the first 12 hours of admission provided strong independent predictors of in-hospital mortality in elderly acute stroke patients. Our nomogram may guide interventions to improve acute care of stroke. A total of 462 elderly patients who were admitted to our neuroscience service for acute stroke diagnosis between 2005 and 2009 were included as the “training dataset.” The first “test dataset” included 122 patients from 2010 to 2012, and second “test data” included 123 patients from 2016 to 2017. Overall, length of stay was a median (interquartile range [IQR]) of 12 days (7–19 d) for patients who survived and 6 days (4–11 d) for patients who died.

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