Stroke-Associated Pneumonia Risk Score: Validity in a French Stroke Unit
Introduction
Post-stroke functional prognosis is related to acute stroke severity and to the occurrence of medical complications, such as pneumonia, urinary tract infections, or deep venous thrombosis, which overall are observed in one third of the patients.1 Stroke-associated pneumonia (SAP) is one of the most frequent of these complications, between 2.3% and 28% depending on the type of medical ward, and the most disabling with a strong association with a poor functional outcome and mortality.2, 3, 4, 5 Despite significant trends in the reduction of this complication since the development of the stroke units and dedicated medical and paramedical teams,6 SAP remains still too frequent. Therefore, it is becoming mandatory to identify efficient screening tools in order to predict which patient will have higher risks and implement specific strategies to prevent this disorder.6, 7 To this purpose, several risk scores based on routinely available clinically available parameters have been developed in several countries, such as the A2DS2 in Germany,8 the Pneumonia score in Korea,9 the ISAN score in UK,10 and the AIS-APS in China.11 To our knowledge, the feasibility and validity of these scores were not compared on an independent population.12, 13
The aims of this study were to (1) evaluate the in-hospital rate of SAP and mortality in a population of ischemic stroke patients admitted in a French comprehensive stroke center, (2) investigate the feasibility to retrospectively evaluate four risk scores based on data recorded in the stroke unit, and (3) compare the validity of these scores.
Section snippets
Patient Selection
Clinical data from patients admitted to our comprehensive stroke center from November 2012 to April 2015 were retrospectively reviewed from computerized medical records that were filled prospectively during in-hospital stay. The inclusion criteria were age over 15 years old, acute ischemic stroke confirmed on brain imaging (either magnetic resonance imaging or computerized tomography), and assessment of the patient for the occurrence of pneumonia or death during hospitalization. The variables
Baseline Characteristics of the Cohort
From November 2012 to April 2015, a total of 5022 patients were admitted to our comprehensive stroke center. Among them, 2555 had an ischemic stroke, 59% were men, the mean age was 71 years old (interquartile range [IQR]: 59-81), and the median NIHSS score on admission was 8 (IQR: 4-17). In this group, the rates of in-hospital pneumonia and mortality were, respectively, 8.6% (n = 219) and 2.9% (n = 75).
Score Feasibility
Overall, all components were available for calculation of the Pn, A2DS2, and ISAN scores.
Discussion
The main results of this large single-center retrospective study are that (1) about 10% of stroke patients admitted in a comprehensive stroke unit have an SAP, (2) most of the screening tests could already be performed in our stroke units without changing our clinical practice, and (3) overall clinical utility of the different tests is the same, the simple being as efficient as the more complex.
In this study, the in-hospital SAP prevalence was 8.6%, which could be considered in the middle
References (21)
- et al.
Age-based prediction of incidence of complications during inpatient stroke rehabilitation: a retrospective longitudinal cohort study
BMC Geriatr
(2014) - et al.
Medical complications in patients with stroke: data validity in a stroke registry and a hospital discharge registry
Clin Epidemiol
(2010) - et al.
Influence of acute complications on outcome 3 months after ischemic stroke
PLoS ONE
(2013) - et al.
Post-stroke infection: a systematic review and meta-analysis
BMC Neurol
(2011) - et al.
Combination of acute stroke unit and short-term stroke ward with early supported discharge decreases mortality and complications after acute ischemic stroke
J Med Assoc Thai
(2007) - et al.
Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept
J Neurol
(2010) - et al.
NIHSS and acute complications after anterior and posterior circulation strokes
Ther Clin Risk Manag
(2012) - et al.
Development of a clinical score (A2DS2) to predict pneumonia in acute ischemic stroke
Stroke
(2012) - et al.
The Pneumonia score: a simple grading scale for prediction of pneumonia after acute stroke
Am J Infect Control
(2006) - et al.
Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study
J Am Heart Assoc
(2015)
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