Variation of stroke associated pneumonia in stroke units across England and Wales: a registry based cohort study

Marco Lobo Chaves, Matthew Gittins, Benjamin Bray, Andy Vail, Craig Smith

Research output: Contribution to journalArticlepeer-review


Pneumonia is common in stroke patients and is associated with worse clinical outcomes. Prevalence of stroke associated pneumonia (SAP) varies between studies, and reasons for this variation remain unclear. We aimed to describe the variation of observed SAP in England and Wales and explore the influence of patient baseline characteristics on this variation.
Patient data was obtained from the Sentinel Stroke National Audit Programme for all confirmed strokes between 1 April 2013 to 31 December 2018. SAP was defined by new antibiotic initiation for pneumonia within the first 7 days of admission. The probability of SAP occurrence within stroke units was estimated and compared using a multilevel mixed model with and without adjustment for patient level characteristics at admission.
Of the 413,133 patients included, median NIHSS was 4 (IQR 2-10) and 42.3% were aged over 80 years. SAP was identified in 8.5% of patients. The median within stroke unit SAP prevalence was 8.5% (IQR 6.1% - 11.5%) with a maximum of 21.4%. The mean and variance of the predicted SAP probability across stroke units decreased from 0.08 (0.68) to 0.05 (0.63) when adjusting for patient admission characteristics. This difference in the variance suggests that clinical characteristics account for 5% of the observed variation in SAP between units.
Patient level clinical characteristics contributed minimally to the observed variation of SAP between stroke units. Additional explanations for the observed variation in SAP need to be explored which could reduce variation in antibiotic use for stroke patients.
Original languageEnglish
JournalInternational Journal of Stroke
Publication statusAccepted/In press - 21 Jan 2021


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