ACDD4score: A simple tool for assessing risk of pneumonia after stroke.
BACKGROUND
Pneumonia is a serious but a preventable stroke complication. Prediction scales for post-stroke pneumonia have been proposed with an intent to improve surveillance and prevention but they remain under-utilized in clinical practice. Most existing scales were developed using both ventilated and non-ventilated patients which may affect their accuracy. We derived and validated a novel, pragmatic scale to predict hospital-acquired pneumonia (HAP) after stroke employing only a non-ventilated stroke cohort.


METHODS
All consecutive patients admitted with acute stroke to a large hospital in Boston, Massachusetts, were identified using International Classification of Diseases, 9th revision (ICD-9) codes for acute ischemic strokes, intracerebral hemorrhages and confirmed by chart review. The following exclusion criteria were used: stroke occurring after hospitalization, pneumonia on admission, intubation, presence of brain or lung neoplasms, admission<48hours duration. HAP was defined using discharge ICD-9 codes. The association of relevant covariates with HAP was analyzed using multivariable stepwise logistic regression analysis to develop a scoring system and validated using bootstrapping.


RESULTS
A total of 1644 patients met study criteria; 144 (8.8%) developed HAP. An 8-point pneumonia prediction scale (ACDD4) was derived using significant covariates (age≥75=1; congestive heart failure=1; dysarthria=1; dysphagia=4). The risk of pneumonia varied between 2% and 33.9% with scores of 0 to 7, respectively. The c-statistic of the final model was 0.82 and bootstrap validation c-statistic was 0.81.


CONCLUSIONS
ACDD4scale is a promising tool for predicting HAP in non-ventilated stroke patients that can be easily computed at the patient's bedside. Subject term: cerebrovascular disease/stroke.
Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States. Electronic address: skumar@bidmc.harvard.edu.
Sandeep
S
Kumar
Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Sarah
S
Marchina
Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States.
Joseph
J
Massaro
Department of Neuroscience, MUSC Stroke Center, Medical University of South Carolina, Charleston, SC, United States.
Wayne
W
Feng
Department of Neurology, University of Kentucky Medical Center, Lexington, KY, United States.
Sourabh
S
Lahoti
Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
Magdy
M
Selim
Harvard Medical School, Boston, MA, United States; Department of Neurology, University of Kentucky Medical Center, Lexington, KY, United States; Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Shoshana J
SJ
Herzig
D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology*; D011237:Predictive Value of Tests; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*
Hospital-acquired pneumonia prediction; Infection; Risk score; Stroke care