TOPLINE:

A novel algorithm showed 93% accuracy in predicting risk for poststroke pneumonia in a new study, with tracheostomy status, aspiration, cough frequency, malnutrition, and cognitive impairment identified as key risk factors.

METHODOLOGY:

• A prospective case-control study involved more than 300 patients (mean age, 63 years; 59.5% men) admitted at a tertiary hospital in South Korea from 2019 to 2024. All patients had confirmed ischemic or hemorrhagic stroke and signs or symptoms of dysphagia.
• Participants underwent comprehensive evaluations within 24 hours of admission, including a videofluoroscopic swallowing study (VFSS), a modified cough reflex test, the Mini-Mental State Examination (MMSE) to measure cognition, and serum albumin levels to measure nutritional status. Patients were followed for 4 weeks.
• Pneumonia was diagnosed according to Mann criteria, with risk categorized as none (< 2% incidence), low (2%-25% incidence), and high (> 25% incidence).
• Outcomes included the incidence of pneumonia, along with the identification of risk predictors for pneumonia in patients with stroke.

TAKEAWAY:

• Pneumonia developed in 8.5% of patients within 4 weeks. Patients with vs without pneumonia had significantly higher rates of tracheostomy (54% vs 11%, respectively), VFSS-confirmed aspiration (71% vs 23.5%), and bilateral hemispheric lesions (64% vs 23%) and lower mean MMSE scores (8.2 vs 18.4) and mean serum albumin levels (3.6 vs 4.0 g/dL; P < .01 for all).
• Tracheostomy status was the strongest predictor of risk for pneumonia (odds ratio [OR], 9.3), followed by VFSS‑confirmed aspiration (OR, 8.2) and bilateral stroke lesions (OR, 5.9; P < .001 for all). MMSE scores, cough frequency, and albumin levels also showed significant associations (P < .005 for all).
• 31% of patients who underwent tracheostomy developed pneumonia compared with 5% of those who did not have the procedure. Patients with tracheostomy and a cough frequency < 3 showed high pneumonia risk, especially with an MMSE score < 6 (50% vs 19% for scores ≥ 6). In patients who did not undergo tracheostomy, VFSS‑confirmed aspiration with serum albumin levels < 3.5 g/dL was associated with a 62.5% pneumonia risk.
• The predictive algorithm showed 93% accuracy, with an area under the curve of 0.89. Overall accuracy was 99% in the no-risk group.

IN PRACTICE:

“This algorithm offers a comprehensive framework for poststroke pneumonia screening and may facilitate early preventive interventions for at-risk patients,” the investigators wrote. 

“Future studies with larger, more diverse samples, including higher-risk cohorts, and external multicenter validation will be needed before wider clinical implementation,” they added.

SOURCE:

The study was led by Jong Weon Lee, Yonsei University College of Medicine, Seoul, South Korea. It was published online on November 19 in Frontiers in Neurology.

LIMITATIONS:

The study used VFSS for aspiration detection, but its limited availability and feasibility in some patients may have reduced accessibility. The small sample size and exclusion of higher‑risk patients, such as those needing supplemental oxygen or with active pneumonia, limited generalizability. Dysphagia assessment lacked the use of standardized scales, which may have affected reproducibility. The model also lacked head‑to‑head comparison with existing predictive models; and potential predictors such as oral hygiene were not assessed due to the unavailability of standardized tools.

DISCLOSURES:

The investigators reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.