Risk factors for chest infection in acute stroke: a prospective cohort study.
OBJECTIVE
Pneumonia is a major cause of morbidity and mortality after stroke. We aimed to determine key characteristics that would allow prediction of those patients who are at highest risk for poststroke pneumonia.


METHODS
We studied a series of consecutive patients with acute stroke who were admitted to hospital. Detailed evaluation included the modified National Institutes of Health Stroke Scale; the Abbreviated Mental Test; and measures of swallow, respiratory, and oral health status. Pneumonia was diagnosed by set criteria. Patients were followed up at 3 months after stroke.


RESULTS
We studied 412 patients, 391 (94.9%) with ischemic stroke and 21 (5.1%) with hemorrhagic stroke; 78 (18.9%) met the study criteria for pneumonia. Subjects who developed pneumonia were older (mean+/-SD age, 75.9+/-11.4 vs 64.9+/-13.9 years), had higher modified National Institutes of Health Stroke Scale scores, a history of chronic obstructive pulmonary disease, lower Abbreviated Mental Test scores, and a higher oral cavity score, and a greater proportion tested positive for bacterial cultures from oral swabs. In binary logistic-regression analysis, independent predictors (P<0.05) of pneumonia were age >65 years, dysarthria or no speech due to aphasia, a modified Rankin Scale score > or =4, an Abbreviated Mental Test score <8, and failure on the water swallow test. The presence of 2 or more of these risk factors carried 90.9% sensitivity and 75.6% specificity for the development of pneumonia.


CONCLUSIONS
Pneumonia after stroke is associated with older age, dysarthria/no speech due to aphasia, severity of poststroke disability, cognitive impairment, and an abnormal water swallow test result. Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.
Sellars
Cameron
C
Academic Section of Geriatric Medicine, Glasgow Royal Infirmary, Glasgow, UK. Cameron.Sellars@northglasgow.scot.nhs.uk
Bowie
Lynsey
L
Bagg
Jeremy
J
Sweeney
M Petrina
MP
Miller
Hazel
H
Tilston
Jennifer
J
Langhorne
Peter
P
Stott
David J
DJ
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D003072:Cognition Disorders / Q000150:complications / Q000503:physiopathology; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000150:complications / Q000503:physiopathology; D004185:Disability Evaluation; D004401:Dysarthria / Q000150:complications / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D011014:Pneumonia / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D012307:Risk Factors; D020521:Stroke / Q000150:complications*