Vasileios Papavasileiou1, Haralampos Milionis2, Craig J Smith3, Konstantinos Makaritsis4, Benjamin D Bray5, Patrik Michel6, Efstathios Manios7, Konstantinos Vemmos7, George Ntaios4. 1. Comprehensive Stroke Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford Royal Foundation Trust, Manchester M6 8HD, UK. Electronic address: Vasileios.Papavasileiou@srft.nhs.uk. 2. Department of Medicine, Ioannina University Hospital, School of Medicine, University of Ioannina, Ioannina, Greece. 3. Comprehensive Stroke Centre, Salford Royal NHS Foundation Trust, Manchester Academic Health Sciences Centre, Salford Royal Foundation Trust, Manchester M6 8HD, UK; Stroke and Vascular Research Centre, Institute of Cardiovascular Sciences, University of Manchester, Manchester, UK. 4. Department of Medicine, Larissa University Hospital, School of Medicine, University of Thessaly, Larissa, Greece. 5. Division of Health and Social Care Research, King's College London, UK. 6. Neurology Service, CHUV, University of Lausanne, Lausanne, Switzerland. 7. Department of Clinical Therapeutics, Medical School of Athens, Alexandra Hospital, Athens, Greece.
Abstract
BACKGROUND AND PURPOSE: The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN) score was developed recently for predicting stroke-associated pneumonia (SAP), one of the most common complications after stroke. The aim of the present study was to externally validate the ISAN score. METHODS: Data included in the Athens Stroke Registry between June 1992 and December 2011 were used for this analysis. Inclusion criteria were the availability of all ISAN score variables (prestroke independence, sex, age, National Institutes of Health Stroke Scale score). Receiver operating characteristic curves and linear regression analyses were used to determine the discriminatory power of the score and to assess the correlation between actual and predicted pneumonia in the study population. Separate analyses were performed for patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). RESULTS: The analysis included 3204 patients (AIS: 2732, ICH: 472). The ISAN score demonstrated excellent discrimination in patients with AIS (area under the curve [AUC]: .83 [95% confidence interval {CI}: .81-.85]). In the ICH group, the score was less effective (AUC: .69 [95% CI: .63-.74]). Higher-risk groups of ISAN score were associated with an increased relative risk of SAP; risk increase was more prominent in the AIS population. Predicted pneumonia correlated very well with actual pneumonia (AIS group: R(2) = .885; β-coefficient = .941, P < .001; ICH group: R(2) = .880, β-coefficient = .938, P < .001). CONCLUSIONS: In our external validation in the Athens Stroke Registry cohort, the ISAN score predicted SAP very accurately in AIS patients and demonstrated good discriminatory power in the ICH group. Further validation and assessment of clinical usefulness would strengthen the score's utility further.
BACKGROUND AND PURPOSE: The Prestroke Independence, Sex, Age, National Institutes of Health Stroke Scale (ISAN) score was developed recently for predicting stroke-associated pneumonia (SAP), one of the most common complications after stroke. The aim of the present study was to externally validate the ISAN score. METHODS: Data included in the Athens Stroke Registry between June 1992 and December 2011 were used for this analysis. Inclusion criteria were the availability of all ISAN score variables (prestroke independence, sex, age, National Institutes of Health Stroke Scale score). Receiver operating characteristic curves and linear regression analyses were used to determine the discriminatory power of the score and to assess the correlation between actual and predicted pneumonia in the study population. Separate analyses were performed for patients with acute ischemic stroke (AIS) and intracerebral hemorrhage (ICH). RESULTS: The analysis included 3204 patients (AIS: 2732, ICH: 472). The ISAN score demonstrated excellent discrimination in patients with AIS (area under the curve [AUC]: .83 [95% confidence interval {CI}: .81-.85]). In the ICH group, the score was less effective (AUC: .69 [95% CI: .63-.74]). Higher-risk groups of ISAN score were associated with an increased relative risk of SAP; risk increase was more prominent in the AIS population. Predicted pneumonia correlated very well with actual pneumonia (AIS group: R(2) = .885; β-coefficient = .941, P < .001; ICH group: R(2) = .880, β-coefficient = .938, P < .001). CONCLUSIONS: In our external validation in the Athens Stroke Registry cohort, the ISAN score predicted SAP very accurately in AIS patients and demonstrated good discriminatory power in the ICH group. Further validation and assessment of clinical usefulness would strengthen the score's utility further.
Authors: Amit K Kishore; Andy Vail; Benjamin D Bray; Angel Chamorro; Mario Di Napoli; Lalit Kalra; Peter Langhorne; Joan Montaner; Christine Roffe; Anthony G Rudd; Pippa J Tyrrell; Diederik van de Beek; Mark Woodhead; Andreas Meisel; Craig J Smith Journal: Eur Stroke J Date: 2016-06-01
Authors: Antonio Di Carlo; Maria Lamassa; Marco Franceschini; Francesca Bovis; Lorenzo Cecconi; Sanaz Pournajaf; Stefano Paravati; Annibale Biggeri; Domenico Inzitari; Salvatore Ferro Journal: PLoS One Date: 2018-03-23 Impact factor: 3.240
Authors: Willeke F Westendorp; Jan-Dirk Vermeij; Nina A Hilkens; Matthijs C Brouwer; Ale Algra; H Bart van der Worp; Diederik Wj Dippel; Diederik van de Beek; Pual J Nederkoorn Journal: Eur Stroke J Date: 2018-03-08