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Title: Chest infection within 30 days of acute stroke, associated factors, survival and the benefits of stroke unit care: Analysis using linked data from the Australian Stroke Clinical Registry.
Austin Authors: Chapman, Chantelle;Cadilhac, Dominique A;Morgan, Prue;Kilkenny, Monique F;Grimley, Rohan;Sundararajan, Vijaya;Purvis, Tara;Johnston, Trisha;Lannin, Natasha A;Andrew, Nadine E
Affiliation: Stroke and Ageing Research, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria Australia
Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Melbourne, VIC Australia
Occupational Therapy Department, Alfred Health, Prahran, Victoria Australia
Health Statistics Branch, Queensland Department of Health, Brisbane, Queensland Australia
Department of Medicine, St. Vincent's Hospital, Melbourne University, Melbourne, Victoria Australia
Department of Public Health, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria Australia
Sunshine Coast Clinical School, University of Queensland, Birtinya, Queensland Australia
The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria Australia
College of Science, Health and Engineering, School of Allied Health, La Trobe University, Bundoora, Victoria Australia
Issue Date: Jun-2020
Date: 2019-02-21
Publication information: International Journal of Stroke 2020; 15(4): 390-398
Abstract: Chest infections following acute stroke contribute to increased morbidity and mortality. We aimed to investigate factors associated with chest infections that occur within 30 days of stroke, the impact on 90-day survival, and the role of stroke unit care. Patient-level data from the Australian Stroke Clinical Registry (2010-13; 23 Queensland hospitals), were linked with Queensland hospital admission, emergency department (ED), and national death registry data. Acute chest infections were determined using ICD-10 codes from the stroke admission, hospital readmissions, ED contacts, and cause of death data. Patients aged ≥18 years without a prior stroke or chronic respiratory condition were included. Multilevel (hospital and patient) multivariable regression and survival analysis were used to identify associated factors and the influence on 90-day survival. Overall, 3149 patients (77% ischemic stroke, 47% female, median age 74 years) were included; 3.1% developed a chest infection within 30 days. Associated factors included: admission to intensive care (OR: 8.26, 95% CI: 4.07, 16.76); and urinary tract infection (OR: 3.09, 95% CI: 1.89, 5.04). Patients not treated in stroke units had a two-fold greater odds of chest infections (OR: 1.96, 95% CI: 1.25, 3.05). Chest infection afforded a greater hazard of death at 90 days (HR: 1.42, 95% CI 1.04, 1.93). This was reduced for those admitted to a stroke unit (HR: 1.31, 95% CI 0.99, 1.75). Results emphasize the need for active prevention and highlight the importance of stroke unit care in mitigating risk and improving survival in those with stroke-related chest infections.
DOI: 10.1177/1747493019833008
ORCID: 0000-0001-8162-682X
Journal: International Journal of Stroke
PubMed URL: 30789321
Type: Journal Article
Subjects: Stroke
chest infection
data linkage
Stroke unit care
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