Sandeep Kumar1, Sarah Marchina2, Joseph Massaro3, Wayne Feng4, Sourabh Lahoti5, Magdy Selim6, Shoshana J Herzig7. 1. Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. Electronic address: skumar@bidmc.harvard.edu. 2. Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, MA, United States. 3. Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States. 4. Department of Neuroscience, MUSC Stroke Center, Medical University of South Carolina, Charleston, SC, United States. 5. Department of Neurology, University of Kentucky Medical Center, Lexington, KY, United States. 6. Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. 7. Harvard Medical School, Boston, MA, United States; Department of Neurology, University of Kentucky Medical Center, Lexington, KY, United States; Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Abstract
BACKGROUND: Pneumonia is a serious but a preventable stroke complication. Prediction scales for post-stroke pneumonia have been proposed with an intent to improve surveillance and prevention but they remain under-utilized in clinical practice. Most existing scales were developed using both ventilated and non-ventilated patients which may affect their accuracy. We derived and validated a novel, pragmatic scale to predict hospital-acquired pneumonia (HAP) after stroke employing only a non-ventilated stroke cohort. METHODS: All consecutive patients admitted with acute stroke to a large hospital in Boston, Massachusetts, were identified using International Classification of Diseases, 9th revision (ICD-9) codes for acute ischemic strokes, intracerebral hemorrhages and confirmed by chart review. The following exclusion criteria were used: stroke occurring after hospitalization, pneumonia on admission, intubation, presence of brain or lung neoplasms, admission<48hours duration. HAP was defined using discharge ICD-9 codes. The association of relevant covariates with HAP was analyzed using multivariable stepwise logistic regression analysis to develop a scoring system and validated using bootstrapping. RESULTS: A total of 1644 patients met study criteria; 144 (8.8%) developed HAP. An 8-point pneumonia prediction scale (ACDD4) was derived using significant covariates (age≥75=1; congestive heart failure=1; dysarthria=1; dysphagia=4). The risk of pneumonia varied between 2% and 33.9% with scores of 0 to 7, respectively. The c-statistic of the final model was 0.82 and bootstrap validation c-statistic was 0.81. CONCLUSION: ACDD4 scale is a promising tool for predicting HAP in non-ventilated stroke patients that can be easily computed at the patient's bedside. Subject term: cerebrovascular disease/stroke.
BACKGROUND:Pneumonia is a serious but a preventable stroke complication. Prediction scales for post-stroke pneumonia have been proposed with an intent to improve surveillance and prevention but they remain under-utilized in clinical practice. Most existing scales were developed using both ventilated and non-ventilated patients which may affect their accuracy. We derived and validated a novel, pragmatic scale to predict hospital-acquired pneumonia (HAP) after stroke employing only a non-ventilated stroke cohort. METHODS: All consecutive patients admitted with acute stroke to a large hospital in Boston, Massachusetts, were identified using International Classification of Diseases, 9th revision (ICD-9) codes for acute ischemic strokes, intracerebral hemorrhages and confirmed by chart review. The following exclusion criteria were used: stroke occurring after hospitalization, pneumonia on admission, intubation, presence of brain or lung neoplasms, admission<48hours duration. HAP was defined using discharge ICD-9 codes. The association of relevant covariates with HAP was analyzed using multivariable stepwise logistic regression analysis to develop a scoring system and validated using bootstrapping. RESULTS: A total of 1644 patients met study criteria; 144 (8.8%) developed HAP. An 8-point pneumonia prediction scale (ACDD4) was derived using significant covariates (age≥75=1; congestive heart failure=1; dysarthria=1; dysphagia=4). The risk of pneumonia varied between 2% and 33.9% with scores of 0 to 7, respectively. The c-statistic of the final model was 0.82 and bootstrap validation c-statistic was 0.81. CONCLUSION: ACDD4 scale is a promising tool for predicting HAP in non-ventilated strokepatients that can be easily computed at the patient's bedside. Subject term: cerebrovascular disease/stroke.
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
Authors: Małgorzata Kołpa; Marta Wałaszek; Anna Różańska; Zdzisław Wolak; Jadwiga Wójkowska-Mach Journal: Int J Environ Res Public Health Date: 2018-09-07 Impact factor: 3.390