The pneumonia score: A simple grading scale for prediction of pneumonia after acute stroke

Medical complications are an important clinical problem after acute stroke and present potential barriers to optimal recovery. Pneumonia has been estimated to occur in one third of all stroke victims and is the most common respiratory complication. 1 Roth E.J. Medical complications encountered in stroke rehabilitation. Phys Med Rehab Clin North Am. 1991; 2: 563-578 Google Scholar Moreover, a recent study showed that pneumonia increases the risk of 30-day mortality. 2 Katzan I.L. Cebul R.D. Husak S.H. Dawson N.V. Baker D.W. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology. 2003; 60: 620-625 Crossref PubMed Scopus (400) Google Scholar In patients with acute stroke, most stroke deaths after the first week and before 30 days were reported to be due to complications of immobility (ie, pneumonia or pulmonary embolism). 3 Silver F.L. Norris J.W. Lewis A.J. Hachinski V.C. Early mortality following stroke: a prospective review. Stroke. 1984; 15: 492-496 Crossref PubMed Scopus (418) Google Scholar , 4 Bamford J. Dennis M. Sandercock P. Burn J. Warlow C. The frequency, causes and timing of death within 30 days of a first stroke: the Oxfordshire Community Stroke Project. J Neurol Neurosurg Psychiatry. 1990; 53: 824-829 Crossref PubMed Scopus (291) Google Scholar Because pneumonia is critical in the functional status and prognosis, rapid assessment of a high-risk patient of pneumonia is needed. Some studies found that the neurologic deficit as rated on the National Institutes of Health stroke scale (NIHSS) was correlated with pneumonia 5 Dromerick A. Reding M. Medical and neurological complications during inpatient stroke rehabilitation. Stroke. 1994; 25: 358-361 Crossref PubMed Scopus (189) Google Scholar , 6 Grau A.J. Buggle F. Schnitzler P. Spiel M. Lichy C. Hacke W. Fever and infection early ischemic stroke. J Neurol Sci. 1999; 171: 115-120 Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar , 7 Hilker R. Poetter C. Findeisen N. Sobesky J. Jacobs A. Neveling M. et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke. 2003; 34: 975-981 Crossref PubMed Scopus (319) Google Scholar and observed that dysphagia and mechanical ventilation were also associated with pneumonia. 2 Katzan I.L. Cebul R.D. Husak S.H. Dawson N.V. Baker D.W. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology. 2003; 60: 620-625 Crossref PubMed Scopus (400) Google Scholar , 7 Hilker R. Poetter C. Findeisen N. Sobesky J. Jacobs A. Neveling M. et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke. 2003; 34: 975-981 Crossref PubMed Scopus (319) Google Scholar Stroke patients with paralysis and those with impaired level of consciousness also had had higher rates of pneumonia. 2 Katzan I.L. Cebul R.D. Husak S.H. Dawson N.V. Baker D.W. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology. 2003; 60: 620-625 Crossref PubMed Scopus (400) Google Scholar , 8 Thompson R.S. Hall N.K. Szpiech M. Reisenberg L.A. Treatments and outcomes of nursing-home-acquired pneumonia. J Am Board Fam Pract. 1997; 10: 82-87 PubMed Google Scholar Despite the abundant studies of several important risk factors, 1 Roth E.J. Medical complications encountered in stroke rehabilitation. Phys Med Rehab Clin North Am. 1991; 2: 563-578 Google Scholar , 2 Katzan I.L. Cebul R.D. Husak S.H. Dawson N.V. Baker D.W. The effect of pneumonia on mortality among patients hospitalized for acute stroke. Neurology. 2003; 60: 620-625 Crossref PubMed Scopus (400) Google Scholar , 5 Dromerick A. Reding M. Medical and neurological complications during inpatient stroke rehabilitation. Stroke. 1994; 25: 358-361 Crossref PubMed Scopus (189) Google Scholar , 6 Grau A.J. Buggle F. Schnitzler P. Spiel M. Lichy C. Hacke W. Fever and infection early ischemic stroke. J Neurol Sci. 1999; 171: 115-120 Abstract Full Text Full Text PDF PubMed Scopus (123) Google Scholar , 7 Hilker R. Poetter C. Findeisen N. Sobesky J. Jacobs A. Neveling M. et al. Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke. 2003; 34: 975-981 Crossref PubMed Scopus (319) Google Scholar , 8 Thompson R.S. Hall N.K. Szpiech M. Reisenberg L.A. Treatments and outcomes of nursing-home-acquired pneumonia. J Am Board Fam Pract. 1997; 10: 82-87 PubMed Google Scholar , 9 Davenport R.J. Dennis M.S. Wellwood I. Warlow C. Complications after acute stroke. Stroke. 1996; 27: 415-420 Crossref PubMed Scopus (504) Google Scholar no grading scale for development of pneumonia after acute stroke is yet used. The purpose of this study was to define a clinical grading scale for pneumonia, which is predictive of incidence of pneumonia development and can be rapidly and accurately assessed at the early time after stroke onset.