Abstract
BackgroundPneumonia is common in stroke patients and is associated with worse clinical outcomes. Prevalence of stroke-associated pneumonia varies between studies, and reasons for this variation remain unclear. We aimed to describe the variation of observed stroke-associated pneumonia in England and Wales and explore the influence of patient baseline characteristics on this variation.MethodsPatient data were obtained from the Sentinel Stroke National Audit Programme for all confirmed strokes between 1 April 2013 and 31 December 2018. Stroke-associated pneumonia was defined by new antibiotic initiation for pneumonia within the first seven days of admission. The probability of stroke-associated pneumonia occurrence within stroke units was estimated and compared using a multilevel mixed model with and without adjustment for patient-level characteristics at admission.ResultsOf the 413,133 patients included, median National Institutes of Health Stroke Scale was 4 (IQR: 2–10) and 42.3% were aged over 80 years. Stroke-associated pneumonia was identified in 8.5% of patients. The median within stroke unit stroke-associated pneumonia prevalence was 8.5% (IQR: 6.1–11.5%) with a maximum of 21.4%. The mean and variance of the predicted stroke-associated pneumonia probability across stroke units decreased from 0.08 (0.68) to 0.05 (0.63) when adjusting for patient admission characteristics. This difference in the variance suggests that clinical characteristics account for 5% of the observed variation in stroke-associated pneumonia between units.ConclusionsPatient-level clinical characteristics contributed minimally to the observed variation of stroke-associated pneumonia between stroke units. Additional explanations for the observed variation in stroke-associated pneumonia need to be explored which could reduce variation in antibiotic use for stroke patients.
Highlights
Stroke-associated pneumonia (SAP) is a complication defined as the spectrum of lower respiratory tract infection complicating the first seven days after stroke admission.[1,2]
17,980 (8.76%) developed SAP, while 17,007 (8.00%) of the male patients developed SAP, of those patients over 80 years of age, 21,359 (13.9%) developed SAP, 31,889 (8.53%) of patients of white ethnicity developed SAP, and 29,460 (8.04%) of patients admitted due to ischemic stroke developed SAP
Our findings show that there is substantial variation of observed SAP episodes, and antibiotic use for pneumonia, across stroke units in England and Wales
Summary
Stroke-associated pneumonia (SAP) is a complication defined as the spectrum of lower respiratory tract infection complicating the first seven days after stroke admission.[1,2] It is associated with increased mortality, worse outcomes in survivors, and increased length of hospital stay.[3]. The underlying reasons for this variation are uncertain, but could include potentially modifiable or non-modifiable factors. Baseline characteristics, such as increased stroke severity, increased age, and dysphagia,[5] are consistently associated with SAP and might contribute to variation in reported SAP. Pneumonia is common in stroke patients and is associated with worse clinical outcomes. Prevalence of stroke-associated pneumonia varies between studies, and reasons for this variation remain unclear. We aimed to describe the variation of observed stroke-associated pneumonia in England and Wales and explore the influence of patient baseline characteristics on this variation
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
