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Stroke. 2015 May;46(5):1202-9. doi: 10.1161/STROKEAHA.114.007843. Epub 2015 Apr 9.

How is pneumonia diagnosed in clinical stroke research? A systematic review and meta-analysis.

Author information

1
From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre-Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de Terrassa, Barcelona, Spain (J.G.); Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy (M.D.N.); Clinical Neurosciences, King's College Hospital NHS Foundation Trust London, UK (L.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK (P.L.); Laboratorio de Investigación Neurovascular, Unidad Neurovascular, Servicio de Neurología Hospital Vall d' Hebron, Barcelona (J.M.); IBIS Stroke Programme, Hospital Virgen del Rocio, Sevilla, Spain (J.M.); Keele University Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Stoke-on-Trent, UK (C.R.); Department of Health and Social Care, Kings College, London, UK (A.G.R.); Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (D.v.d.B.); Faculty of Medical and Human Sciences, University of Manchester and Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester,UK (M.W.); and NeuroCure Clinical Research Center, Center for Stroke Research-Berlin, Department of Neurology Charité Universitaetsmedizin Berlin, Germany (A.M.).
2
From the Stroke and Vascular Research Centre, University of Manchester, Institute of Cardiovascular Sciences, Greater Manchester Comprehensive Stroke Centre-Salford Royal Foundation Trust, UK (A.K.K., S.J.H., P.J.T., C.J.S.); Centre for Biostatistics, University of Manchester, Salford Royal Foundation Trust, UK (A.V.); Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona, Barcelona, Spain (A.C.); Department of Medicine, Hospital Universitari Mutua de Terrassa, Barcelona, Spain (J.G.); Neurological Service, San Camillo de' Lellis General Hospital, Rieti, Italy (M.D.N.); Clinical Neurosciences, King's College Hospital NHS Foundation Trust London, UK (L.K.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK (P.L.); Laboratorio de Investigación Neurovascular, Unidad Neurovascular, Servicio de Neurología Hospital Vall d' Hebron, Barcelona (J.M.); IBIS Stroke Programme, Hospital Virgen del Rocio, Sevilla, Spain (J.M.); Keele University Institute for Science and Technology in Medicine, Guy Hilton Research Centre, Stoke-on-Trent, UK (C.R.); Department of Health and Social Care, Kings College, London, UK (A.G.R.); Department of Neurology, Center for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands (D.v.d.B.); Faculty of Medical and Human Sciences, University of Manchester and Department of Respiratory Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester,UK (M.W.); and NeuroCure Clinical Research Center, Center for Stroke Research-Berlin, Department of Neurology Charité Universitaetsmedizin Berlin, Germany (A.M.). Craig.Smith-2@manchester.ac.uk.

Abstract

BACKGROUND AND PURPOSE:

Diagnosis of pneumonia complicating stroke is challenging, and there are currently no consensus diagnostic criteria. As a first step in developing such consensus-based diagnostic criteria, we undertook a systematic review to identify the existing diagnostic approaches to pneumonia in recent clinical stroke research to establish the variation in diagnosis and terminology.

METHODS:

Studies of ischemic stroke, intracerebral hemorrhage, or both, which reported occurrence of pneumonia from January 2009 to March 2014, were considered and independently screened for inclusion by 2 reviewers after multiple searches using electronic databases. The primary analysis was to identify existing diagnostic approaches for pneumonia. Secondary analyses explored potential reasons for any heterogeneity where standard criteria for pneumonia had been applied.

RESULTS:

Sixty-four studies (56% ischemic stroke, 6% intracerebral hemorrhage, 38% both) of 639 953 patients were included. Six studies (9%) reported no information on the diagnostic approach, whereas 12 (19%) used unspecified clinician-reported diagnosis or initiation of antibiotics. The majority used objective diagnostic criteria: 20 studies (31%) used respiratory or other published standard criteria; 26 studies (41%) used previously unpublished ad hoc criteria. The overall occurrence of pneumonia was 14.3% (95% confidence interval 13.2%-15.4%; I(2)=98.9%). Occurrence was highest in studies applying standard criteria (19.1%; 95% confidence interval 15.1%-23.4%; I(2)=98.5%). The substantial heterogeneity observed was not explained by stratifying for other potential confounders.

CONCLUSIONS:

We found considerable variation in terminology and the diagnostic approach to pneumonia. Our review supports the need for consensus development of operational diagnostic criteria for pneumonia complicating stroke.

KEYWORDS:

diagnosis; hemorrhage; pneumonia; stroke

PMID:
25858238
DOI:
10.1161/STROKEAHA.114.007843
[Indexed for MEDLINE]

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