TY  - JOUR
A1  - Hillmann, Steffi
A1  - Wiedmann, Silke
A1  - Fraser, Alec
A1  - Baeza, Juan
A1  - Rudd, Anthony
A1  - Norrving, Bo
A1  - Asplund, Kjell
A1  - Niewada, Maciej
A1  - Dennis, Martin
A1  - Hermanek, Peter
A1  - Wolfe, Charles D. A.
A1  - Heuschmann, Peter U.
T1  - Temporal changes in the quality of acute stroke care in five national audits across Europe
JF  - BioMed Research International
N2  - Background. Data on potential variations in delivery of appropriate stroke care over time are scarce. We investigated temporal changes in the quality of acute hospital stroke care across five national audits in Europe over a period of six years. Methods. Data were derived from national stroke audits in Germany, Poland, Scotland, Sweden, and England/Wales/Northern Ireland participating within the European Implementation Score (EIS) collaboration. Temporal changes in predefined quality indicators with comparable information between the audits were investigated. Multivariable logistic regression analyses were performed to estimate adherence to quality indicators over time. Results. Between 2004 and 2009, individual data from 542,112 patients treated in 538 centers participating continuously over the study period were included. In most audits, the proportions of patients who were treated on a SU, were screened for dysphagia, and received thrombolytic treatment increased over time and ranged from 2-fold to almost 4-fold increase in patients receiving thrombolytic therapy in 2009 compared to 2004. Conclusions. A general trend towards a better quality of stroke care defined by standardized quality indicators was observed over time. The association between introducing a specific measure and higher adherence over time might indicate that monitoring of stroke care performance contributes to improving quality of care.
KW  - ischemic stroke
KW  - indicators
KW  - thrombolysis
KW  - registries
KW  - outcomes
KW  - mortality
KW  - implementation
KW  - German Stroke Registers Study Group
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-149059
VL  - 2015
IS  - 432497
ER  - 
TY  - JOUR
A1  - Smith, Craig J.
A1  - Bray, Benjamin D.
A1  - Hoffman, Alex
A1  - Meisel, Andreas
A1  - Heuschmann, Peter U.
A1  - Wolfe, Charles D. A.
A1  - Tyrrell, Pippa J.
A1  - Rudd, Anthony G.
T1  - Can a novel clinical risk score improve pneumonia prediction in acute stroke care? A UK multicenter cohort study
JF  - Journal of the American Heart Association
N2  - Background
Pneumonia frequently complicates stroke and has amajor impact on outcome. We derived and internally validated a simple clinical risk score for predicting stroke-associated pneumonia (SAP), and compared the performance with an existing score (A\(^{2}\)DS\(^{2}\)). 

Methods and Results
We extracted data for patients with ischemic stroke or intracerebral hemorrhage from the Sentinel Stroke National Audit Programme multicenter UK registry. The data were randomly allocated into derivation (n=11 551) and validation (n=11 648) samples. A multivariable logistic regression model was fitted to the derivation data to predict SAP in the first 7 days of admission. The characteristics of the score were evaluated using receiver operating characteristics (discrimination) and by plotting predicted versus observed SAP frequency in deciles of risk (calibration). Prevalence of SAP was 6.7% overall. The final 22-point score (ISAN: prestroke Independence [modified Rankin scale], Sex, Age, National Institutes of Health Stroke Scale) exhibited good discrimination in the ischemic stroke derivation (C-statistic 0.79; 95% CI 0.77 to 0.81) and validation (C-statistic 0.78; 95% CI 0.76 to 0.80) samples. It was well calibrated in ischemic stroke and was further classified into meaningful risk groups (low 0 to 5, medium6 to 10, high 11 to 14, and very high >= 15) associated with SAP frequencies of 1.6%, 4.9%, 12.6%, and 26.4%, respectively, in the validation sample. Discrimination for both scores was similar, although they performed less well in the intracerebral hemorrhage patients with an apparent ceiling effect. 

Conclusions
The ISAN score is a simple tool for predicting SAP in clinical practice. External validation is required in ischemic and hemorrhagic stroke cohorts.
KW  - acute ischemic stroke
KW  - medical complications
KW  - infection
KW  - diagnosis
KW  - stroke-associated pneumonia
KW  - clinical risk score
KW  - pneumonia
KW  - stroke, acute
KW  - metaanalysis
KW  - reliability
KW  - dysphagia
KW  - scale
KW  - mortality
KW  - intracerebral hemorrhage
Y1  - 2015
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-144602
VL  - 4
IS  - 1
ER  -