Amit K Kishore1, Andy Vail2, Benjamin D Bray3, Angel Chamorro4, Mario Di Napoli5, Lalit Kalra6, Peter Langhorne7, Joan Montaner8,9, Christine Roffe10, Anthony G Rudd11, Pippa J Tyrrell1, Diederik van de Beek12, Mark Woodhead13,14, Andreas Meisel15, Craig J Smith1. 1. Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences; Greater Manchester Neurosciences Centre, Salford Royal NHS Foundation Trust, Salford, UK. 2. Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, Salford, UK. 3. King's College, London, UK. 4. Comprehensive Stroke Centre, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain. 5. Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy. 6. Clinical Neurosciences, King's College Hospital NHS Foundation Trust London, London, UK. 7. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK. 8. Laboratorio de Investigación Neurovascular, Unidad Neurovascular, Servicio de Neurología Hospital Vall d' Hebron, Barcelona, Spain. 9. IBIS Stroke Programme, Hospital Virgen del Rocio, Sevilla, Spain. 10. Keele University Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Stoke-on-Trent, UK. 11. Department of Health and Social Care, King's College, London, UK. 12. Department of Neurology, Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands. 13. Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK. 14. Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK. 15. NeuroCure Clinical Research Centre, Centre for Stroke Research Berlin; Department of Neurology, Charité Universitaetsmedizin Berlin, Berlin, Germany.
Abstract
PURPOSE: Several risk stratification scores for predicting stroke-associated pneumonia have been derived. We aimed to evaluate the performance and clinical usefulness of such scores for predicting stroke-associated pneumonia. METHOD: A systematic literature review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, with application of the Quality Assessment of Diagnostic Accuracy-2 tool. Published studies of hospitalised adults with ischaemic stroke, intracerebral haemorrhage, or both, which derived and validated an integer-based clinical risk score, or externally validated an existing score to predict occurrence of stroke-associated pneumonia, were considered and independently screened for inclusion by two reviewers. FINDINGS: We identified nine scores, from eight derivation cohorts. Age was a component of all scores, and the NIHSS score in all except one. Six scores were internally validated and five scores were externally validated. The A2DS2 score (Age, Atrial fibrillation, Dysphagia, Severity [NIHSS], Sex) was the most externally validated in 8 independent cohorts. Performance measures were reported for eight scores. Discrimination tended to be more variable in the external validation cohorts (C statistic 0.67-0.83) than the derivation cohorts (C statistic 0.74-0.85). DISCUSSION: Overall, discrimination and calibration were similar between the different scores. No study evaluated influence on clinical decision making or prognosis. CONCLUSION: The clinical prediction scores varied in their simplicity of use and were comparable in performance. Utility of such scores for preventive intervention trials and in clinical practice remains uncertain and requires further study.
PURPOSE: Several risk stratification scores for predicting stroke-associated pneumonia have been derived. We aimed to evaluate the performance and clinical usefulness of such scores for predicting stroke-associated pneumonia. METHOD: A systematic literature review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, with application of the Quality Assessment of Diagnostic Accuracy-2 tool. Published studies of hospitalised adults with ischaemic stroke, intracerebral haemorrhage, or both, which derived and validated an integer-based clinical risk score, or externally validated an existing score to predict occurrence of stroke-associated pneumonia, were considered and independently screened for inclusion by two reviewers. FINDINGS: We identified nine scores, from eight derivation cohorts. Age was a component of all scores, and the NIHSS score in all except one. Six scores were internally validated and five scores were externally validated. The A2DS2 score (Age, Atrial fibrillation, Dysphagia, Severity [NIHSS], Sex) was the most externally validated in 8 independent cohorts. Performance measures were reported for eight scores. Discrimination tended to be more variable in the external validation cohorts (C statistic 0.67-0.83) than the derivation cohorts (C statistic 0.74-0.85). DISCUSSION: Overall, discrimination and calibration were similar between the different scores. No study evaluated influence on clinical decision making or prognosis. CONCLUSION: The clinical prediction scores varied in their simplicity of use and were comparable in performance. Utility of such scores for preventive intervention trials and in clinical practice remains uncertain and requires further study.
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