The Timing of Stroke Care Processes and Development of Stroke Associated Pneumonia: A National Registry Cohort Study

Abstract

IntroductionTimely stroke care can result in significant improvements in stroke recovery. However, little is known about how stroke care processes relate to complications such as the development of stroke associated pneumonia (SAP). Here we investigated associations between stroke care processes, their timing and development of SAP.MethodsWe obtained patient-level data from the Sentinel Stroke National Audit Programme for all confirmed strokes between 1st April 2013 and 31st December 2018. SAP was identified if new antibiotic initiation for pneumonia occurred within the first 7 days of admission. Time to key stroke care processes in the pre-hospital, hyperacute and acute phase were investigated. A mixed effects logistic regression model estimated the association between SAP [Odds ratios (OR) with 95% CI] and each process of care after controlling for pre-determined confounders such as age, stroke severity and comorbidities.ResultsSAP was identified in 8.5% of 413,133 patients in 169 stroke units. A long time to arrival at a stroke unit after symptom onset or time last seen well [OR (95% CI) = 1.29 (1.23–1.35)], from admission to assessment by a stroke specialist [1.10 (1.06–1.14)] and from admission to assessment by a physiotherapist [1.16 (1.12–1.21)] were all independently associated with SAP. Short door to needle times were associated with lower odds of SAP [0.90 (0.83–0.97)].ConclusionTimes from stroke onset and admission to certain key stroke care processes were associated with SAP. Understanding how timing of these care processes relate to SAP may enable development of preventive interventions to reduce antibiotic use and improve clinical outcomes.

Predictors of dysphagia screening and pneumonia among patients with intracerebral haemorrhage in China: a cross-sectional hospital-based retrospective study

“… 35 39 Therefore, early screening and rehabilitation of dysphagia can improve cough reflex, as well as reduce the aspiration and pneumonia incidence. 8 40 41 Our findings further confirm that dysphagia is an independent risk factor for pneumonia; further, the dysphagia rate in patients with pneumonia was about four times that of patients with normal swallowing function. Screening for swallowing function may reduce pneumonia incidence.…”

“…Delays in screening and assessment were associated with pneumonia; further, pre–post comparison revealed that screening for swallowing disorders by nurses reduced the pneumonia rate and the length of hospital stay 35 39. Therefore, early screening and rehabilitation of dysphagia can improve cough reflex, as well as reduce the aspiration and pneumonia incidence 8 40 41. Our findings further confirm that dysphagia is an independent risk factor for pneumonia; further, the dysphagia rate in patients with pneumonia was about four times that of patients with normal swallowing function.…”

“…Pneumonia is a complication presented by one-third of all patients with ICH2–4 and is associated with increased in-hospital mortality risk, prolonged hospital stay and higher healthcare costs 5–7. Prevention of pneumonia is fundamental to improve the prognosis of ICH patients 8. Identifying potentially modifiable factors associated with pneumonia could improve patient outcomes and reduce antibiotic use, which is a priority for the currently increasing antimicrobial resistance 9.…”

“…[5][6][7] Prevention of pneumonia is fundamental to improve the prognosis of ICH patients. 8 Identifying potentially modifiable factors associated with pneumonia could improve patient outcomes and reduce antibiotic use, which is a priority for the currently increasing antimicrobial resistance. 9 The process of care, which should be in a concrete and organised manner and use multidisciplinary management, determines the frequency of several complications, including pneumonia in stroke patients.…”

Does stroke-associated pneumonia play an important role on risk of in-hospital mortality associated with severe stroke? A four-way decomposition analysis of a national cohort of stroke patients

“…15 Patients with ischaemic or haemorrhagic stroke were included, though patients at stroke units with less than a maximum of 150 patients in any of the 5-year period were excluded. 16 This was to better reflect International Journal of Stroke, 18 (9) patients experience at established specialist stroke units. Patients with a time from stroke onset to hospital admission greater than 24 h were also excluded, to avoid delayed stroke presentations where pneumonia may already have developed between stroke onset and admission.…”