Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome

Teh, Wen-Hui; Smith, Craig J.; Barlas, Raphae S.; Wood, Andy; Bettencourt‐Silva, Joao H.; Clark, Allan; Metcalf, Anthony K.; Bowles, Kristian M.; Potter, John F.; Myint, Phyo Kyaw

doi:10.1111/ane.12956

Cited by 124 publications

(110 citation statements)

References 34 publications

(86 reference statements)

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“…The risk of aspiration assessed by GUSS in our study (50-60% according to the definition) is similar to the original study [7] but also to another independent study that used the GUSS test in an ASU setting [18]. Likewise, the prevalence of SAP was similar to that reported in the literature [1,19] and was significantly higher in patients with dysphagia or at risk of aspiration, which has also been previously demonstrated [20]. It is interesting to note that, in our study, the predictive value of the identification of dysphagia (using the 10-mL water-swallowing test) and risk of aspiration (using the GUSS test) for the occurrence of SAP was independent of admission stroke severity and further supports the need for a systematic dysphagia screening administered by experienced professionals.…”

Section: Discussionsupporting

confidence: 88%

Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke

Lopes

Freitas

Oliveira

et al. 2018

Euro J of Neurology

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Background and purpose Post‐stroke dysphagia occurs in up to three quarters of patients with acute stroke and is associated with a higher risk of respiratory infections and poor outcome. Systematic screening of dysphagia in the acute stroke unit is essential to identify patients at risk of aspiration and to provide dietary recommendations. Our study aimed to assess the impact of the systematic application of the Gugging Swallowing Screen (GUSS) in patients with acute ischaemic stroke. Methods This was a retrospective study of consecutive patients with acute ischaemic stroke admitted to an acute stroke unit in two time periods: pre‐GUSS (February 2014–July 2015), when the 10‐mL water‐swallowing test was systematically administered, and GUSS (August 2015–October 2016), when the GUSS test was systematically administered. Groups were compared with regard to baseline and stroke characteristics, and the occurrence of stroke‐associated pneumonia (SAP), in‐hospital death and 3‐month outcome. Results Of the 344 patients who were included in the study (median age 71 years), 51.7% were male with a median National Institutes of Health Stroke Scale score of 11. A total of 204 patients were included during the pre‐GUSS period and 140 during the GUSS period. Patients in the GUSS period more frequently had diabetes and partial anterior circulation syndromes, and were more frequently treated with thrombectomy. There was no difference in the occurrence of SAP between the two groups (pre‐GUSS, 12.5%; GUSS, 15.1%; P = 0.490) and no differences were found concerning in‐hospital mortality (P = 0.996), 3‐month functional independence (P = 0.647) or 3‐month mortality (P = 0.598). Conclusions The systematic administration of GUSS in a population of patients with acute ischaemic stroke did not reduce the occurrence of SAP, mortality or 3‐month functional dependence when compared with the systematic administration of the 10‐mL water‐swallowing test.

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Section: Discussionsupporting

confidence: 88%

Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke

Lopes

Freitas

Oliveira

et al. 2018

Euro J of Neurology

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“…When the results of this study are compared to the literature for CAP which is usually caused by viral or bacterial infection there appear to be some overlap. Age predicts survival at 1 month and 6 months in CAP in the literature and for SAP the current study [8,[13][14][15]. When comparing to the CURB-65 score for CAP, we did not find an association between serum urea concentrations at diagnosis of SAP and mortality [9].…”

Section: Discussionmentioning

confidence: 55%

Predictors of mortality and disability in stroke-associated pneumonia

et al. 2019

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Whilst stroke-associated pneumonia (SAP) is common and associated with poor outcomes, less is known about the determinants of these adverse clinical outcomes in SAP. To identify the factors that influence mortality and morbidity in SAP. Data for patients with SAP (n = 854) were extracted from a regional Hospital Stroke Register in Norfolk, UK (2003-2015). SAP was defined as pneumonia occurring within 7 days of admission by the treating clinicians. Mutlivariable regression models were constructed to assess factors influencing survival and the level of disability at discharge using modified Rankin Scale [mRS]. Mean (SD) age was 83.0 (8.7) years and ischaemic stroke occurred in 727 (85.0%). Mortality was 19.0% at 30 days and 44.0% at 6 months. Stroke severity assessment using National Institutes of Health Stroke Scale was not recorded in the data set although Oxfordshire Community Stroke Project was Classification. In the multivariable analyses, 30-day mortality was independently associated with age (OR 1.04, 95% CI 1.01-1.07, p = 0.01), haemorrhagic stroke (2.27, 1.07-4.78, p = 0.03) and pre-stroke disability (mRS 4-5 v 0-1: 6.45, 3.12-13.35, p < 0.001). 6-month mortality was independently associated with age (< 0.001), pre-stroke disability (p < 0.001) and certain comorbidities, including the following: dementia (6.53, 4.73-9.03, p < 0.001), lung cancer (2.07, 1.14-3.77, p = 0.017) and previous transient ischemic attack (1.94, 1.12-3.36, p = 0.019). Disability defined by mRS at discharge was independently associated with age (1.10, 1.05-1.16, p < 0.001) and plasma C-reactive protein (1.02, 1.01-1.03, p = 0.012). We have identified non-modifiable determinants of poor prognosis in patients with SAP. Further studies are required to identify modifiable factors which may guide areas for intervention to improve the prognosis in SAP in these patients.

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“…Stroke-associated pneumonia (SAP) accounts for 18% of all nosocomial infections and is the most common infection in patients with ICH, especially for the elderly [3]. SAP not only increases the length of hospital stay and hospital costs [4,5], but is also an important risk factor for poor outcomes after acute stroke [6,7]. Therefore, it is important to nd a scale that is effective in predicting SAP and can help clinicians take early preventative measures to reduce the incidence of SAP [8,9].…”

Section: Introductionmentioning

confidence: 99%

The Feasibility of the Braden Scale for Assessing Pneumonia After Spontaneous Intracerebral Hemorrhage

Ding

Zhao

et al. 2020

Preprint

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Background Stroke-associated pneumonia (SAP) is an infection that commonly occurs in patients with spontaneous intracerebral hemorrhage (ICH) and causes serious burdens. The six subscales of the Braden scale seem to be related to the occurrence of pneumonia. We aimed to evaluate the feasibility of the Braden scale for predicting SAP after spontaneous ICH. Methods Patients with spontaneous ICH who were admitted to Jingjiang People’s Hospital and Zhoukou Central Hospital were retrospectively included and divided into two groups: the pneumonia and no pneumonia groups. The Braden scale and ICH-APS-A scale scores and demographic and clinical characteristics were collected, and the differences between the two groups were compared with statistical analyses. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive validity of the Braden scale for SAP after ICH. Results A total of 629 patients with ICH were included in this study, 150 (23.8%) of whom developed SAP. There were significant differences in age and fasting blood glucose level between the two groups, and the ICH-ASP-A score in the pneumonia group was significantly higher than that in the no pneumonia group (8.5 ± 3.9 vs 4.9 ± 3.2, P < 0.01). The mean score on the Braden scale in the pneumonia group was significantly lower than that in the no pneumonia group (16.5 ± 2.6, P < 0.01). The area under the curve (AUC) for the ICH-ASP-A score for the prediction of pneumonia after spontaneous ICH was 0.755 (95% CI = 0.712–0.798). When the cutoff point was 8 points, the sensitivity was 56.7% and the specificity was 77.5%. The AUC for the Braden scale for the prediction of pneumonia after ICH was 0.760 (95% CI = 0.717–0.804). When the cutoff point was 15 points, the sensitivity was 74.3% and the specificity was 64.7%. Conclusions The Braden scale is effective in predicting pneumonia after ICH. The Braden scale, with a cutoff point of 15 points, is a valid clinical grading scale for predicting SAP after spontaneous ICH.

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Impact of stroke-associated pneumonia on mortality, length of hospitalization, and functional outcome

Cited by 124 publications

References 34 publications

Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke

Impact of the systematic use of the Gugging Swallowing Screen in patients with acute ischaemic stroke

Predictors of mortality and disability in stroke-associated pneumonia

The Feasibility of the Braden Scale for Assessing Pneumonia After Spontaneous Intracerebral Hemorrhage

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