Westendorp et al reported a score for predicting pneumonia in a patient with an acute stroke. This can help to identify a patient who may benefit from more aggressive management. The authors are from multiple institutions in the Netherlands participating in the Preventive Antibiotics in Stroke Study (PASS).
Patient selection: adult with acute stroke
Parameters:
(1) age in years
(2) sex
(3) history of COPD
(4) prestroke modified Rankin scale, from 0 to 6
(5) intracranial hemorrhage
(6) NIHSS for stroke severity
(7) dysphagia
Parameter
Finding
Points
age
<= 50 years
0
51 to 60 years
1
61 to 70 years
2
71 to 80 years
3
> 80 years
4
sex
female
0
male
2
COPD
no
0
yes
2
pre-stroke disability
0
0
1 or 2
2
3 to 6
1
intracerebral hemorrhage
no
0
yes
1
NIHSS
0 to 5
0
6 to 10
2
11 to 20
4
21 to 30
6
dysphagia
no
0
yes
5
where:
• Points for modified Rankin scale are reverse of what might be expected.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 22
Score
Risk Group
Pneumonia
<= 5
low
1%
6 to 10
moderate
4%
11 to 15
high
17%
16 to 22
very high
29%
Performance:
• The area under the ROC curve is 0.84.
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