Deans' stroke musings: The Timing of Stroke Care Processes and Development of Stroke Associated Pneumonia: A National Registry Cohort Study

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Thursday, April 28, 2022

The Timing of Stroke Care Processes and Development of Stroke Associated Pneumonia: A National Registry Cohort Study

Well then, should the pneumonia vaccine be a protocol to prevent that problem? Provide solutions instead of just lazily just describing a problem. Does no one in stroke have any functioning brain cells at all?

Pneumonia Vaccine: Should I Get It? - WebMD

The latest here:

The Timing of Stroke Care Processes and Development of Stroke Associated Pneumonia: A National Registry Cohort Study

Marco Antonio Lobo Chaves^1,2^*,

Matthew Gittins^2,3,

Benjamin Bray⁴,

Andy Vail^2,3 and

Craig J. Smith^1,2,5

¹Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom
²Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom
³Centre for Biostatistics, University of Manchester, Manchester, United Kingdom
⁴School of Population Health and Environmental Sciences, King's College London, London, United Kingdom
⁵Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal National Health Service (NHS) Foundation Trust, Salford, United Kingdom

Introduction: Timely stroke care can result in significant improvements in stroke recovery. However, little is known about how stroke care processes relate to complications such as the development of stroke associated pneumonia (SAP). Here we investigated associations between stroke care processes, their timing and development of SAP.

Methods: We obtained patient-level data from the Sentinel Stroke National Audit Programme for all confirmed strokes between 1st April 2013 and 31st December 2018. SAP was identified if new antibiotic initiation for pneumonia occurred within the first 7 days of admission. Time to key stroke care processes in the pre-hospital, hyperacute and acute phase were investigated. A mixed effects logistic regression model estimated the association between SAP [Odds ratios (OR) with 95% CI] and each process of care after controlling for pre-determined confounders such as age, stroke severity and comorbidities.

Results: SAP was identified in 8.5% of 413,133 patients in 169 stroke units. A long time to arrival at a stroke unit after symptom onset or time last seen well [OR (95% CI) = 1.29 (1.23–1.35)], from admission to assessment by a stroke specialist [1.10 (1.06–1.14)] and from admission to assessment by a physiotherapist [1.16 (1.12–1.21)] were all independently associated with SAP. Short door to needle times were associated with lower odds of SAP [0.90 (0.83–0.97)].

Conclusion: Times from stroke onset and admission to certain key stroke care processes were associated with SAP. Understanding how timing of these care processes relate to SAP may enable development of preventive interventions to reduce antibiotic use and improve clinical outcomes.

Introduction

Stroke Associated Pneumonia (SAP) occurs in around 7–13% of patients during the first 7 days of admission with a stroke (1). SAP is independently associated with worse functional outcomes, increased mortality and healthcare costs related to stroke care (2). Identification of potentially modifiable factors associated with SAP could ultimately lead to improved patient outcomes and reduce antibiotic use, which is a priority in an era of increasing antimicrobial resistance (3).

There are currently few strategies available to reduce the risk of SAP. Early swallow assessment and receipt of organized stroke unit care are associated with lower risk of SAP development (4, 5), yet little is known about how other care processes relate to risk of SAP. Preventive antibiotics have not been shown to reduce the risk of SAP or improve clinical outcomes. Other interventions, such as oral care and metoclopramide may reduce the risk of SAP, but require further evaluation (6, 7).

Better understanding the relationships between stroke care processes, their timing and the risk of SAP could provide a basis for interventions to improve patient outcomes and antibiotic stewardship. The main aim of this study was therefore to investigate the associations between the timing of stroke care processes spanning pre-hospital, hyperacute and acute care and the development of SAP.