Abstract
BackgroundThis review aims to evaluate the performance and clinical applicability of the A2DS2 scale via systematic review and meta-analysis.MethodsThe Medline, Embase, Cochrane Library, CBM, CNKI, and Wanfang databases were searched. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Funnel plots and Egger’s test were used to evaluate publication bias. The bivariate random-effect model was used for calculating the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, diagnostic odds ratio, and area under the curve (AUC). A Fagan nomogram was applied to evaluate the clinical applicability of the A2DS2 scale.ResultsA total of 29 full-text articles met the inclusion criteria, including 19,056 patients. Bivariate mixed-effects regression models yielded a mean sensitivity of 0.78 (95 % CI: 0.73–0.83), a specificity of 0.79 (95 % CI: 0.73–0.84), a positive likelihood ratio of 3.7 (95 % CI: 2.9–4.6), and a negative likelihood ratio of 0.27 (95 % CI: 0.23–0.33). The area under the receiver operating characteristic curve was 0.85 (95 % CI: 0.82–0.88). If given a pre-test probability of 50 %, the Fagan nomogram showed that when A2DS2 was positive, the post-test probability improved to 79 %. In contrast, when A2DS2 was negative, it decreased to 22 %. The results of the subgroup analysis showed no effect on the diagnostic accuracy of the A2DS2 scale in predicting stroke-associated pneumonia, except for the optimal cut-off value.ConclusionsThe A2DS2 scale demonstrates high clinical applicability and could be a valid scale for the early prediction of stroke-associated pneumonia in stroke patients.
Highlights
This review aims to evaluate the performance and clinical applicability of the A2DS2 scale via systematic review and meta-analysis
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The inclusion criteria were as follows: (1) prospective or retrospective clinical studies; (2) patients diagnosed with stroke; (3) patients met the diagnostic criteria for pneumonia [10,11,12] and stroke [13]; and (4) the true positive value, false positive value, true negative value and false negative value of the A2DS2 scale could be obtained directly or indirectly to predict pneumonia in patients with stroke
Summary
This review aims to evaluate the performance and clinical applicability of the A2DS2 scale via systematic review and meta-analysis. Stroke-associated pneumonia (SAP) is a common medical complication of stroke that affects 5.60–37.98 % of stroke patients [1]. Delays in the diagnosis or treatment of SAP increase disease mortality, prolong the length of hospital stay, and increase medical costs. It is necessary to find an early and reliable method to predict the risk of SAP. Various risk factors for SAP have been reported. SAP risk factors include mechanical ventilation, atrial fibrillation, pre-existing respiratory disease, smoking, pre-existing heart disease, and dysphasia [3]. Combined with the SAP risk factors, some researchers in different regions established several early prediction SAP scales, such as the A2DS2 scale and the PANTHERS scale in Germany, the ISAN scale in Britain, and the AIS-APS scale in China [4–
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