Reliability of the validated clinical diagnosis of pneumonia on validated outcomes after intracranial hemorrhage

Naidech, Andrew M.; Liebling, Storm; Duran, Isis M.; Moore, Michael J.; Wunderink, Richard G.; Zembower, Teresa

doi:10.1016/j.jcrc.2011.11.009

Cited by 14 publications

(9 citation statements)

References 26 publications

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“…However, this might reflect clinical routine and recent studies showed that poor interrater reliability also applies to validated standardized criteria. 29,30 Moreover, our reported rate of pneumonia is comparable to that of other large studies and a meta-analysis on poststroke infections, 31,32 making large quantities of misdiagnoses of poststroke pneumonia unlikely.…”

Section: Discussionsupporting

confidence: 82%

Development of a Clinical Score (A ² DS ² ) to Predict Pneumonia in Acute Ischemic Stroke

Höffmann

Malzahn

Harms

et al. 2012

Stroke

194

163

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; for the Berlin Stroke Register and the Stroke Register of Northwest Germany Background and Purpose-Poststroke pneumonia is a potentially preventable complication after stroke associated with poor outcome. We developed and externally validated a prognostic score for predicting risk of pneumonia after ischemic stroke. Methods-The prognostic score was developed based on clinical data routinely collected after admission from the Berlin Stroke Register, Germany. The association of demographics, comorbidities, and clinical characteristics with poststroke pneumonia was investigated using multivariable logistic regression analyses. Independent predictors of poststroke pneumonia were translated into a point scoring system based on the corresponding regression coefficients. The predictive properties of the developed prognostic score were externally validated using an independent data set from the Stroke Register Northwest-Germany. Results-Between 2007 and 2009, 15 335 patients with ischemic stroke were registered within the Berlin Stroke Register.The observed rate of pneumonia in hospital was 7.2%. A 10-point score was derived for prediction of poststroke pneumonia (Age Ն75 yearsϭ1, Atrial fibrillationϭ1, Dysphagiaϭ2, male Sexϭ1, stroke Severity, National Institutes of Health Stroke Scale 0 -4ϭ0, 5-15ϭ3, Ն16ϭ5; A 2 DS 2 ). The proportion of pneumonia varied between 0.3% in patients with a score of 0 point to 39.4% in patients with a score of 10 points. The score demonstrated excellent discrimination (C-statistic 0.84; 95% CI, 0.83-0.85) and calibration (McFadden R 2 ϭ0.21). Prediction, discrimination, and calibration properties were reproduced in the validation cohort consisting of 45 085 patients with ischemic stroke. Conclusions-The

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Section: Discussionsupporting

confidence: 82%

Development of a Clinical Score (A ² DS ² ) to Predict Pneumonia in Acute Ischemic Stroke

Höffmann

Malzahn

Harms

et al. 2012

Stroke

194

163

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“…We had to rely on the clinician's best judgment to determine whether the mechanism of pneumonia was aspiration or non-aspiration and this carries a margin of error. 34 However, the data TA B L E 3 Odds/hazards ratio with corresponding 95% confidence intervals at different time periods for mortality outcomes and long length of hospital stay for patients with SAP compared to those without who were admitted to the regional stroke unit (2003 to 2015) came from a single unit with yearly patient flow of approximately 1000 per annum stroke cases looked after by a single stroke team with 3-5 consultants during the study period. The shift system within the NHS suggests that most patients were looked after by more than one consultant in each hospital episode, and hence, any disagreement in diagnosis would have been resolved with final coding verified.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…In a prospective study of patients with ICH and subarachnoid hemorrhage, inter-rater reliability between clinicians applying the CDC criteria for pneumonia was poor (ĸ=0.30). 83 The lack of standardized diagnostic criteria for lower respiratory tract infections complicating stroke and the variation in diagnostic approach has significant implications in clinical practice and research. In clinical practice, it influences clinical decision-making regarding appropriate use of antibiotics (timing and clinician thresholds for antibiotic initiation), diagnostic uncertainty (consideration of other differential diagnoses), and prognostication.…”

Section: May 2015mentioning

confidence: 99%

How Is Pneumonia Diagnosed in Clinical Stroke Research?

Kishore

Vail

Chamorro

et al. 2015

Stroke

138

120

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Background and Purpose— Diagnosis of pneumonia complicating stroke is challenging, and there are currently no consensus diagnostic criteria. As a first step in developing such consensus-based diagnostic criteria, we undertook a systematic review to identify the existing diagnostic approaches to pneumonia in recent clinical stroke research to establish the variation in diagnosis and terminology. Methods— Studies of ischemic stroke, intracerebral hemorrhage, or both, which reported occurrence of pneumonia from January 2009 to March 2014, were considered and independently screened for inclusion by 2 reviewers after multiple searches using electronic databases. The primary analysis was to identify existing diagnostic approaches for pneumonia. Secondary analyses explored potential reasons for any heterogeneity where standard criteria for pneumonia had been applied. Results— Sixty-four studies (56% ischemic stroke, 6% intracerebral hemorrhage, 38% both) of 639 953 patients were included. Six studies (9%) reported no information on the diagnostic approach, whereas 12 (19%) used unspecified clinician-reported diagnosis or initiation of antibiotics. The majority used objective diagnostic criteria: 20 studies (31%) used respiratory or other published standard criteria; 26 studies (41%) used previously unpublished ad hoc criteria. The overall occurrence of pneumonia was 14.3% (95% confidence interval 13.2%–15.4%; I 2 =98.9%). Occurrence was highest in studies applying standard criteria (19.1%; 95% confidence interval 15.1%–23.4%; I 2 =98.5%). The substantial heterogeneity observed was not explained by stratifying for other potential confounders. Conclusions— We found considerable variation in terminology and the diagnostic approach to pneumonia. Our review supports the need for consensus development of operational diagnostic criteria for pneumonia complicating stroke.

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Reliability of the validated clinical diagnosis of pneumonia on validated outcomes after intracranial hemorrhage

Cited by 14 publications

References 26 publications

Development of a Clinical Score (A ² DS ² ) to Predict Pneumonia in Acute Ischemic Stroke

Development of a Clinical Score (A ² DS ² ) to Predict Pneumonia in Acute Ischemic Stroke

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

How Is Pneumonia Diagnosed in Clinical Stroke Research?

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Reliability of the validated clinical diagnosis of pneumonia on validated outcomes after intracranial hemorrhage

Cited by 14 publications

References 26 publications

Development of a Clinical Score (A 2 DS 2 ) to Predict Pneumonia in Acute Ischemic Stroke

Development of a Clinical Score (A 2 DS 2 ) to Predict Pneumonia in Acute Ischemic Stroke

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

How Is Pneumonia Diagnosed in Clinical Stroke Research?

Contact Info

Product

Resources

About

Development of a Clinical Score (A ² DS ² ) to Predict Pneumonia in Acute Ischemic Stroke

Development of a Clinical Score (A ² DS ² ) to Predict Pneumonia in Acute Ischemic Stroke