TY  - JOUR
A1  - Grube, Maike Miriam
A1  - Koennecke, Hans-Christian
A1  - Walter, Georg
A1  - Meisel, Andreas
A1  - Sobesky, Jan
A1  - Nolte, Christian Hans
A1  - Wellwood, Ian
A1  - Heuschmann, Peter Ulrich
T1  - Influence of Acute Complications on Outcome 3 Months after Ischemic Stroke
JF  - PLOS ONE
N2  - Background: Early medical complications are potentially modifiable factors influencing in-hospital outcome. We investigated the influence of acute complications on mortality and poor outcome 3 months after ischemic stroke.
Methods: Data were obtained from patients admitted to one of 13 stroke units of the Berlin Stroke Registry (BSR) who participated in a 3-months-follow up between June 2010 and September 2012. We examined the influence of the cumulative number of early in-hospital complications on mortality and poor outcome (death, disability or institutionalization) 3 months after stroke using multivariable logistic regression analyses and calculated attributable fractions to determine the impact of early complications on mortality and poor outcome. 
Results: A total of 2349 ischemic stroke patients alive at discharge from acute care were included in the analysis. Older age, stroke severity, pre-stroke dependency and early complications were independent predictors of mortality 3 months after stroke. Poor outcome was independently associated with older age, stroke severity, pre-stroke dependency, previous stroke and early complications. More than 60% of deaths and poor outcomes were attributed to age, pre-stroke dependency and stroke severity and in-hospital complications contributed to 12.3% of deaths and 9.1% of poor outcomes 3 months after stroke.
Conclusion: The majority of deaths and poor outcomes after stroke were attributed to non-modifiable factors. However, early in-hospital complications significantly affect outcome in patients who survived the acute phase after stroke, underlining the need to improve prevention and treatment of complications in hospital.
KW  - hospital medical complications
KW  - quality-of-care
KW  - term mortality
KW  - Barthel-Index
KW  - rankin scale
KW  - risk-factors
KW  - trial
KW  - reliability
KW  - dependency
KW  - predictors
Y1  - 2013
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-128362
SN  - 1932-6203
VL  - 8
IS  - 9
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  -