BACKGROUND AND PURPOSE: Pneumonia has been estimated to occur in about one third of patients after acute stroke. Only limited data are available on stroke-associated pneumonia (SAP) in specialized neurological intensive care units (NICUs). METHODS: We enrolled 124 patients with acute stroke who were treated at our university hospital NICU in a prospective observational study. Incidence rates and risk factors of SAP and long-term clinical outcome were determined. RESULTS: SAP incidence was 21% with a spectrum of pathogens, which is comparable to previously published data on general ICU patients. Mechanical ventilation, multiple location, and vertebrobasilar stroke, as well as dysphagia and abnormal chest x-ray findings, were identified as risk factors for the disease. SAP patients showed higher mortality rates than nondiseased subjects (acute, 26.9% versus 8.2%; long-term, 35.3% versus 14.3%) and a significantly poorer long-term clinical outcome (Barthel Index, 50.5+/-42.4 versus 81.5+/-27.8; Rankin Scale, 3.5+/-1.7 versus 2.2+/-1.6). CONCLUSIONS: Our data underline the considerable epidemiological and prognostic impact of SAP for the treatment of acute stroke patients in a specialized NICU setting. They demonstrate that the occurrence of SAP deteriorates clinical outcome in these patients. Our results allow us to identify high-risk stroke patients at time of NICU admission in whom the use of preventive treatment strategies is most promising.
BACKGROUND AND PURPOSE:Pneumonia has been estimated to occur in about one third of patients after acute stroke. Only limited data are available on stroke-associated pneumonia (SAP) in specialized neurological intensive care units (NICUs). METHODS: We enrolled 124 patients with acute stroke who were treated at our university hospital NICU in a prospective observational study. Incidence rates and risk factors of SAP and long-term clinical outcome were determined. RESULTS:SAP incidence was 21% with a spectrum of pathogens, which is comparable to previously published data on general ICU patients. Mechanical ventilation, multiple location, and vertebrobasilar stroke, as well as dysphagia and abnormal chest x-ray findings, were identified as risk factors for the disease. SAPpatients showed higher mortality rates than nondiseased subjects (acute, 26.9% versus 8.2%; long-term, 35.3% versus 14.3%) and a significantly poorer long-term clinical outcome (Barthel Index, 50.5+/-42.4 versus 81.5+/-27.8; Rankin Scale, 3.5+/-1.7 versus 2.2+/-1.6). CONCLUSIONS: Our data underline the considerable epidemiological and prognostic impact of SAP for the treatment of acute strokepatients in a specialized NICU setting. They demonstrate that the occurrence of SAP deteriorates clinical outcome in these patients. Our results allow us to identify high-risk strokepatients at time of NICU admission in whom the use of preventive treatment strategies is most promising.
Authors: Thomas M Hemmen; Rema Raman; Kama Z Guluma; Brett C Meyer; Joao A Gomes; Salvador Cruz-Flores; Christine A Wijman; Karen S Rapp; James C Grotta; Patrick D Lyden Journal: Stroke Date: 2010-08-19 Impact factor: 7.914
Authors: Jing Qian; Seyedmehdi Payabvash; André Kemmling; Michael H Lev; Lee H Schwamm; Rebecca A Betensky Journal: Biometrics Date: 2013-12-09 Impact factor: 2.571
Authors: Andre D Kumar; Amelia K Boehme; James E Siegler; Michael Gillette; Karen C Albright; Sheryl Martin-Schild Journal: J Stroke Cerebrovasc Dis Date: 2012-09-30 Impact factor: 2.136