Development of a pneumonia risk score for post-acute rehabilitation in patients with severe acquired brain injury.

Abstract

Objective: To develop a pneumonia risk score for patients with severe acquired brain injury (sABI) hospitalized for post-acute rehabilitation.

Methods: A prognostic model with data from 1,625 patients with sABI who were pneumonia-free at admission for rehabilitation. Candidate predictors were gathered within 72 hours following admission. Prognostic risk scores were calculated based on hazard ratios and combined in an overall pneumonia risk score ranging 0-10.

Results: Predictors were age >50 years hazard ratio (HR) 1,83 (95% CI: 1.33; 2.53), male sex HR 2.43 (95% CI: 1.70; 3.46), diagnosis (stroke, traumatic or anoxic brain injury) HR 1.69 (95% CI: 1.12; 2.55), tube feeding HR 4.46 (95% CI: 2.59; 7.70), and functional independence measure score of 18 HR 2.06 (95% CI: 1.10; 3.85). A score of 8-10 encompassed those being at high-risk of pneumonia with a positive predictive value (PPV) of 35% (95% CI: 32-37), a score of 5-7 encompassed those being at medium risk with a PPV of 16% (95% CI: 14-17), and a score of 0-4 encompassed those being at low risk with a PPV of 4% (95%CI: 3-5).

Conclusions: A prognostic score was developed to raise awareness of patients in post-acute rehabilitation who are at high risk of pneumonia. The prognostic score should be externally validated before being used outside the development setting.