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Pneumonia is one of the most common causes of hospital readmission for stroke patients, and it triples the risk of death within a month after hospitalization for acute stroke, according to a study supported by the Agency for Healthcare Research and Quality (HS09969 and T32 HS00059). Pneumonia is thought to occur most often in stroke patients as a result of the difficulty they may have in swallowing, resulting in aspiration of food or liquid into their lungs. This underscores the need to identify at-risk stroke patients and reduce their risk of pneumonia, for example, by performing bedside swallowing evaluations, suggests Irene L. Katzan, M.D., M.S., of Case Western Reserve University, and her colleagues.
The researchers used medical chart and Medicare data to calculate the relative risk (RR) of pneumonia for 30-day mortality in a group of 11,286 Medicare patients admitted for stroke to 29 Cleveland hospitals between 1991 and 1997. They identified pneumonia in 5.6 percent of the patients. The rates of pneumonia were higher in patients with greater stroke severity and features indicating general frailty. After adjusting for pneumonia severity at hospital admission and propensity for pneumonia (for example, poor nutritional status), pneumonia increased the risk of 30-day death three-fold. The researchers estimate that one stroke-related death at 30 days could be avoided for each 11 cases of pneumonia that are prevented.
More details are in "The effect of pneumonia on mortality among patients hospitalized for acute stroke," by Dr. Katzan, R.D. Cebul, M.D., S.H. Husak, B.A., and others, in the February 2003 Neurology 60, pp. 620-625.
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