Organized stroke inpatient care reduces mortality after pneumonia
MedWire News: Ensuring that patients with stroke have access to high levels of organized inpatient care may reduce their risk for dying if they contract pneumonia, research shows.
Patients' likelihood for contracting pneumonia was influenced not by variables related to care, but by factors such as age, gender, stroke severity, and pre-admission dependency.
"Our study suggests that poststroke pneumonia may not necessarily be a preventable event, as the variables associated with pneumonia are not modifiable," say Gustavo Saposnik (University of Toronto, Ontario, Canada) and colleagues.
The team's study included 8251 patients from the Registry of the Canadian Stroke Network from July 2003 through March 2007. Of these, 7.1% contracted pneumonia within 30 days of stroke onset, with most of these cases (97.3%) occurring while the patients were in hospital.
After accounting for confounders, older age, greater stroke severity, male gender, nonlacunar stroke, being functionally dependent before admission, and the presence of dysphagia, coronary artery disease, and chronic obstructive pulmonary disease were all associated with an increased risk for pneumonia.
Of these factors, stroke severity had the largest impact on pneumonia risk; patients with severe strokes (Canadian Neurological Scale [CNS]<4) were 4.17-fold more likely to develop pneumonia than those with mild strokes (CNS>7).
Overall, 12.4% of patients died while in hospital, and rates were much higher among those with pneumonia than those without, at 39.5% versus 10.3%. Patients with pneumonia also had significantly longer hospital stays and poorer functional outcomes than patients without.
Admission to a stroke unit did not affect patients' risk for contracting pneumonia. However, 30-day mortality rates were 35.1% among patients treated on a stroke unit, compared with 41.0% among other patients, equating to a significant 5.9% absolute risk reduction and a 49.6% relative risk reduction. The number needed to treat to prevent one death was 17.
Access to higher levels of organized stroke care had a similar impact, as assessed with the organized care index (OCI), which assigns up to 3 points for access to occupational therapy or physiotherapy, stroke team assessment, and stroke unit admission. Patients with an OCI of 2-3 had 30-day mortality rates of 30.5% versus 60.5% among those with an OCI of 0-1. The absolute and relative risk reductions were 30.0% and 49.6%, respectively. The number needed to treat to prevent one death was just three.
"This might be related to earlier detection and treatment of pneumonia" in patients with access to high levels of organized care, say Saposnik et al in the journal Neurology.
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By Eleanor McDermid