%0 Journal Article
%T Elevated C
%A Andy Vail
%A Craig J Smith
%A Dulka Manawadu
%A John Hodsoll
%A Lalit Kalra
%A Saddif Irshad
%J International Journal of Stroke
%@ 1747-4949
%D 2019
%R 10.1177/1747493018798527
%X Pyrexia-dependent clinical algorithms may under or overdiagnose stroke-associated pneumonia. This study investigates whether inclusion of elevated C-reactive protein as a criterion improves diagnosis. The contribution of C-reactive protein ˋ≡30ˋmg/l as an additional criterion to a Centers for Disease Control and Prevention-based algorithm incorporating pyrexia with chest signs and leukocytosis and/or chest infiltrates to diagnose stroke-associated pneumonia was assessed in 1088 acute stroke patients from 37 UK stroke units. The sensitivity, specificity, and positive predictive value of different approaches were assessed using adjudicated stroke-associated pneumonia as the reference standard. Adding elevated C-reactive protein to all algorithm criteria did not increase diagnostic accuracy compared with the algorithm alone against adjudicated stroke-associated pneumonia (sensitivity 0.74 (95% CI 0.65每0.81) versus 0.72 (95% CI 0.64每0.80), specificity 0.97 (95% CI 0.96每0.98) for both; kappa 0.70 (95% CI 0.63每0.77) for both). In afebrile patients (nˋ=ˋ965), elevated C-reactive protein with chest and laboratory findings had sensitivity of 0.84 (95% CI 0.67每0.93), specificity of 0.99 (95% CI 0.98每1.00), and kappa 0.80 (95% CI 0.70每0.90). The modified algorithm of pyrexia or elevated C-reactive protein and chest signs with infiltrates or leukocytosis had sensitivity of 0.94 (95% CI 0.87每0.97), specificity of 0.96 (95% CI 0.94每0.97), and kappa of 0.88 (95% CI 0.84每0.93) against adjudicated stroke-associated pneumonia. An algorithm consisting of pyrexia or C-reactive protein ≡30ˋmg/l, positive chest signs, leukocytosis, and/or chest infiltrates has high accuracy and can be used to standardize stroke-associated pneumonia diagnosis in clinical or research settings. http://www.isrctn.com/ISRCTN3711845
%K Acute stroke
%K poststroke pneumonia
%K diagnostic accuracy
%K C-reactive protein
%U https://journals.sagepub.com/doi/full/10.1177/1747493018798527