Derivation and Validation of a Clinical System for Predicting Pneumonia in Acute Stroke

被引：126

作者：

Chumbler, Neale R. ^{[1
,2
,5
]}

Williams, Linda S. ^{[1
,3
,5
]}

Wells, Carolyn K. ^{[6
,7
]}

Lo, Albert C. ^{[8
,10
,11
]}

Nadeau, Steven ^{[12
,13
]}

Peixoto, Aldo J.

Gorman, Mark ^{[14
]}

Boice, John L. ^{[15
]}

Concato, John ^{[3
,6
,9
]}

Bravata, Dawn M. ^{[1
,4
,5
,16
]}

机构：

[1] Richard L Roudebush VAMC, VA HSR&D Ctr Excellence Implementing Evidence Bas, Indianapolis, IN USA

[2] Indiana Univ Purdue Univ, Dept Sociol, Indiana Univ, Sch Liberal Arts, Indianapolis, IN 46202 USA

[3] Indiana Univ, Sch Med, Dept Neurol, Indianapolis, IN 46202 USA

[4] Indiana Univ, Sch Med, Dept Internal Med, Indianapolis, IN USA

[5] Regenstrief Inst Hlth Care, Indianapolis, IN 46202 USA

[6] VA Connecticut Healthcare Syst, Clin Epidemiol Res Ctr, West Haven, CT USA

[7] VA Connecticut Healthcare Syst, Med Serv, West Haven, CT USA

[8] Yale Univ, Sch Med, Dept Neurol, New Haven, CT 06510 USA

[9] Yale Univ, Sch Med, Dept Internal Med, New Haven, CT 06510 USA

[10] Brown Univ, Sch Med, Providence Vet Adm Hosp, Providence, RI 02912 USA

[11] Brown Univ, Sch Med, Dept Neurol, Providence, RI 02912 USA

[12] Malcolm Randall VAMC, Neurol Serv, Gainesville, FL USA

[13] Univ Florida, Sch Med, Dept Neurol, Gainesville, FL USA

[14] Univ Vermont, Coll Med, Dept Neurol, Burlington, VT USA

[15] Boise VAMC, Med Serv, Boise, ID USA

[16] VA HSR&D Stroke Qual Enhancement Res Initiat Prog, Indianapolis, IN USA

来源：

NEUROEPIDEMIOLOGY | 2010年 / 34卷 / 04期

关键词：

Pneumonia; Stroke; Clinical prediction; RISK-FACTORS; DYSPHAGIA; ASPIRATION; INFECTION; DIAGNOSIS; MORTALITY;

D O I：

10.1159/000289350

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Aims: We derived and validated a clinical prediction rule that can be used to predict post-stroke pneumonia. Methods: We conducted a retrospective cohort study of patients admitted to hospital with a stroke. The cohort was subdivided into a derivation group and a validation group. Within the derivation group, a point scoring system was developed to predict pneumonia based on a logistic regression model. The point scoring system was then tested within the validation group. Results: Of the 1,363 patients with stroke, 10.5% of patients experienced new pneumonia. The most points were assigned for abnormal swallowing result and history of pneumonia (4 points), followed by greater NIHSS score (3 points), patient being 'found down' at symptom onset (3 points), and age 1 70 years (2 points). A 3-level classification system was created denoting low, medium and high risks of pneumonia, which accurately predicted pneumonia in the validation group. The discriminatory accuracy of the 3-level clinical prediction rule exceeded the acceptable range in both the derivation group (c statistic: 0.78) and validation group (c statistic: 0.76). Conclusion: A simple scoring system was derived and validated. This clinical scoring system may better identify stroke patients who are at high risk of developing new pneumonia. Copyright (C) 2010 S. Karger AG, Basel

引用

页码：193 / 199

页数：7

共 27 条

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