title: Stroke-Associated Pneumonia Risk Score: Validity in a French Stroke Unit.
abstract: BACKGROUND
  Stroke-associated pneumonia is a leading cause of in-hospital death and post-stroke outcome. Screening patients at high risk is one of the main challenges in acute stroke units. Several screening tests have been developed, but their feasibility and validity still remain unclear.
  
  
  OBJECTIVE
  The aim of our study was to evaluate the validity of four risk scores (Pneumonia score, A2DS2, ISAN score, and AIS-APS) in a population of ischemic stroke patients admitted in a French stroke unit.
  
  
  METHODS
  Consecutive ischemic stroke patients admitted to a stroke unit were retrospectively analyzed. Data that allowed to retrospectively calculate the different pneumonia risk scores were recorded. Sensitivity and specificity of each score were assessed for in-hospital stroke-associated pneumonia and mortality. The qualitative and quantitative accuracy and utility of each diagnostic screening test were assessed by measuring the Youden Index and the Clinical Utility Index.
  
  
  RESULTS
  Complete data were available for only 1960 patients. Pneumonia was observed in 8.6% of patients. Sensitivity and specificity were, respectively, .583 and .907 for Pneumonia score, .744 and .796 for A2DS2, and .696 and .812 for ISAN score. Data were insufficient to test AIS-APS. Stroke-associated pneumonia risk scores had an excellent negative Clinical Utility Index (.77-.87) to screen for in-hospital risk of pneumonia after acute ischemic stroke.
  
  
  CONCLUSIONS
  All scores might be useful and applied to screen stroke-associated pneumonia in stroke patients treated in French comprehensive stroke units.
authors.affiliation: Service de MPR, CH Arcachon, La Teste de Buch, France; Service de MPR, CHU de Bordeaux, Bordeaux, France; EA 4136, Université de Bordeaux, Bordeaux, France. Electronic address: emmanuelle.cugy@ch-arcachon.fr.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Cugy
authors.affiliation: Univ. Bordeaux, Bordeaux, France; CHU de Bordeaux, Unité Neurovasculaire, Bordeaux, France; INCIA, UMR 5287, Bordeaux, France.
authors.forename: Igor
authors.initials: I
authors.lastname: Sibon
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology* / Q000401:mortality; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000401:mortality*
keywords: Ischemic stroke; ROC curve; chest infection prediction; pneumonia; predictive value of tests; screening; stroke-associated