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  - 
TY  - JOUR
A1  - Padberg, Inken
A1  - Knispel, Petra
A1  - Zöllner, Susanne
A1  - Sieveking, Meike
A1  - Schneider, Alice
A1  - Steinbrink, Jens
A1  - Heuschmann, Peter U.
A1  - Wellwood, Ian
A1  - Meisel, Andreas
T1  - Social work after stroke: identifying demand for support by recording stroke patients' and carers' needs in different phases after stroke
JF  - BMC Neurology
N2  - Background

Previous studies examining social work interventions in stroke often lack information on content, methods and timing over different phases of care including acute hospital, rehabilitation and out-patient care. This limits our ability to evaluate the impact of social work in multidisciplinary stroke care.

We aimed to quantify social-work-related support in stroke patients and their carers in terms of timing and content, depending on the different phases of stroke care.

Methods

We prospectively collected and evaluated data derived from a specialized “Stroke-Service-Point” (SSP); a “drop in” center and non-medical stroke assistance service, staffed by social workers and available to all stroke patients, their carers and members of the public in the metropolitan region of Berlin, Germany.

Results

Enquiries from 257 consenting participants consulting the SSP between March 2010 and April 2012 related to out-patient and in-patient services, therapeutic services, medical questions, medical rehabilitation, self-help groups and questions around obtaining benefits. Frequency of enquiries for different topics depended on whether patients were located in an in-patient or out-patient setting. The majority of contacts involved information provision. While the proportion of male and female patients with stroke was similar, about two thirds of the carers contacting the SSP were female.

Conclusion

The social-work-related services provided by a specialized center in a German metropolitan area were diverse in terms of topic and timing depending on the phase of stroke care. Targeting the timing of interventions might be important to increase the impact of social work on patient’s outcome.
KW  - Social support
KW  - Stroke
KW  - Rehabilitation
KW  - Social work
KW  - Patient-centered care
Y1  - 2016
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-164691
VL  - 16
IS  - 111
ER  -