Monica S Badve1,2,3, Zien Zhou2,4, Diederik van de Beek5, Craig S Anderson3,6,7,8, Maree L Hackett2,3,9. 1. 1 Department of Neurology, The St George Hospital, Kogarah, Australia. 2. 2 Mental Health Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia. 3. 3 School of Medicine, The University of Sydney, Camperdown, Sydney, Australia. 4. 4 Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 5. 5 University of Amsterdam, Amsterdam University Medical Centers, Amsterdam Neuroscience, Meibergdreef, Amsterdam, The Netherlands. 6. 6 Cardiometabolic Cluster, The George Institute for Global Health, Faculty of Medicine, UNSW, Sydney, Australia. 7. 7 The George Institute China at Peking University Health Science Center, Beijing, China. 8. 8 Neurology Department, Royal Prince Alfred Hospital, Camperdown, Australia. 9. 9 Faculty of Health and Wellbeing, The University of Central Lancashire, Preston, UK.
Abstract
BACKGROUND: Post-stroke pneumonia and other infectious complications are serious conditions whose frequency varies widely across studies. AIMS: We conducted a systematic review to estimate the frequency of post-stroke pneumonia and other types of major infection. SUMMARY OF REVIEW: MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched for prospective studies with consecutive recruitment of stroke patients. The primary outcome was post-stroke pneumonia. Secondary outcomes were any infection and urinary tract infection. Quality assessment was done using Newcastle Ottawa scale. Heterogeneity of estimates across study populations was calculated using Cochran's Q (heterogeneity χ2) and I2 statistics. A total of 47 studies (139,432 patients) with 48 sample populations were eligible for inclusion. Mean age of patients was 68.3 years and their mean National Institute of Health Stroke Scale score was 8.2. The pooled frequency of post-stroke pneumonia was 12.3% (95% confidence interval [CI] 11%-13.6%; I2 = 98%). The pooled frequency from 2011 to 2017 was 13.5% (95% CI 11.8%-15.3%; I2 = 98%) and comparable with earlier periods (P interaction = 0.31). The pooled frequency in studies in stroke units was 8% (95% CI 7.1%-9%; I2 = 78%) and significantly lower than other locations (P interaction = 0.001). The pooled frequency of post-stroke infection was 21% (95% CI 13%-29.3%; I2 = 99%) and of post-stroke urinary tract infection was 7.9% (95% CI 6.7%-9.3%; I2 = 96%). CONCLUSION: Approximately 1 in 10 stroke patients experience pneumonia during the acute period of hospital care. The frequency of post-stroke pneumonia has remained stable in recent decades but is lower in patients receiving stroke unit care compared to management in other ward settings.
BACKGROUND: Post-stroke pneumonia and other infectious complications are serious conditions whose frequency varies widely across studies. AIMS: We conducted a systematic review to estimate the frequency of post-stroke pneumonia and other types of major infection. SUMMARY OF REVIEW: MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched for prospective studies with consecutive recruitment of strokepatients. The primary outcome was post-stroke pneumonia. Secondary outcomes were any infection and urinary tract infection. Quality assessment was done using Newcastle Ottawa scale. Heterogeneity of estimates across study populations was calculated using Cochran's Q (heterogeneity χ2) and I2 statistics. A total of 47 studies (139,432 patients) with 48 sample populations were eligible for inclusion. Mean age of patients was 68.3 years and their mean National Institute of Health Stroke Scale score was 8.2. The pooled frequency of post-stroke pneumonia was 12.3% (95% confidence interval [CI] 11%-13.6%; I2 = 98%). The pooled frequency from 2011 to 2017 was 13.5% (95% CI 11.8%-15.3%; I2 = 98%) and comparable with earlier periods (P interaction = 0.31). The pooled frequency in studies in stroke units was 8% (95% CI 7.1%-9%; I2 = 78%) and significantly lower than other locations (P interaction = 0.001). The pooled frequency of post-stroke infection was 21% (95% CI 13%-29.3%; I2 = 99%) and of post-stroke urinary tract infection was 7.9% (95% CI 6.7%-9.3%; I2 = 96%). CONCLUSION: Approximately 1 in 10 strokepatients experience pneumonia during the acute period of hospital care. The frequency of post-stroke pneumonia has remained stable in recent decades but is lower in patients receiving stroke unit care compared to management in other ward settings.
Authors: Júlia Faura; Alejandro Bustamante; Silvia Reverté; Teresa García-Berrocoso; Mónica Millán; Mar Castellanos; Blanca Lara-Rodríguez; Josep Zaragoza; Oriol Ventura; María Hernández-Pérez; Cecile van Eendenburg; Pere Cardona; Elena López-Cancio; David Cánovas; Joaquín Serena; Marta Rubiera; Antoni Dávalos; Joan Montaner Journal: J Am Heart Assoc Date: 2021-02-26 Impact factor: 5.501