Lobo Chaves Marco Antonio, Gittins Matthew, Bray Benjamin, Vail Andy, Smith Craig J
Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, United Kingdom.
Geoffrey Jefferson Brain Research Centre, Manchester, United Kingdom.
Front Neurol. 2022 Apr 13;13:875893. doi: 10.3389/fneur.2022.875893. eCollection 2022.
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.
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.
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)].
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.
及时的中风护理可显著改善中风恢复情况。然而，对于中风护理过程与诸如中风相关性肺炎（SAP）等并发症之间的关系，我们知之甚少。在此，我们研究了中风护理过程、其时间安排与SAP发生之间的关联。
我们从哨兵中风国家审计计划中获取了2013年4月1日至2018年12月31日期间所有确诊中风患者的个体层面数据。如果在入院的前7天内开始使用新的肺炎抗生素，则认定为发生了SAP。我们研究了院前、超急性期和急性期关键中风护理过程的时间。在控制了年龄、中风严重程度和合并症等预先确定的混杂因素后，使用混合效应逻辑回归模型估计SAP[比值比（OR）及95%置信区间]与每个护理过程之间的关联。
在169个中风单元的413,133名患者中，8.5%被认定发生了SAP。症状发作或最后一次情况良好后到达中风单元的时间较长[OR（95%置信区间）=1.29（1.23 - 1.35）]、从入院到中风专科医生评估的时间较长[1.10（1.06 - 1.14）]以及从入院到物理治疗师评估的时间较长[1.16（1.12 - 1.21）]均与SAP独立相关。较短的门到针时间与较低的SAP发生几率相关[0.90（0.83 - 0.97）]。
从中风发作和入院到某些关键中风护理过程的时间与SAP相关。了解这些护理过程的时间安排与SAP之间的关系，可能有助于制定预防性干预措施，以减少抗生素使用并改善临床结局。
