From a recent audit using clinical observation standards, we have identified that 1 in 4 patients admitted through the Hyperacute Stroke Unit at Oxford University Hospitals deteriorate, and that infection may play an important role in some deteriorations. National monitoring consistently demonstrates that 1 in 10 stroke patients are treated for pneumonia within the first week after admission to hospital, but it remains unclear which patients are at risk of deterioration or pneumonia. The next step is to explore, in detail, routinely collected electronic medical record information, to better understand what happens to patients after admission to hospital with acute stroke, and what role pneumonia plays.
One concern is that patients are given antibiotics too often. The reason for starting antibiotics is usually a combination of clinical findings with raised blood markers of infection, but it has been demonstrated that raised white blood cell count can be associated with brain swelling rather than infection, for example. Clinical trials of giving antibiotics to patients before pneumonia develops have also failed to demonstrate any evidence of benefit.
We aim to use the clinical information to develop a tool to predict which patients will develop pneumonia. With ongoing involvement with the clinical service, we hope that this study can drive improvements in antibiotic usage after stroke.