Abstract Details

Title The burden of post-stroke aspiration pneumonia (PSAP) on clinical outcomes in a Zambian hospital

Topic Global Health and Neuroepidemiology

Presentation(s) Global Health Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 008

Background The burden of cerebrovascular disease is rising in sub-Saharan Africa, where modern acute stroke interventions are often unavailable. Preventing post-stroke complications such as aspiration pneumonia may hold promise for improving outcomes after stroke in resource-limited settings.

Objective

To characterize the burden of post-stroke aspiration pneumonia (PSAP), its risk factors, and its impact on clinical outcomes in a Zambian hospital.

Design/Methods

We conducted a prospective cohort study of adults with stroke admitted to University Teaching Hospital (Lusaka, Zambia) between 12/2019-3/2020. Demographic and clinical parameters were captured serially over the admission, including NIH Stroke Scale (NIHSS), Glasgow Coma Scale (GCS), Modified Rankin Scale (mRS), and nine PSAP indicators (e.g. fever, cough, tachypnea, etc). Possible PSAP was defined as ≥2 indicators present, and PSAP as ≥4 present. T-tests and chi-square tests were used to compare clinical parameters between participants with and without PSAP. Logistic regression was used to assess the relative contributions of age, sex, PSAP status, admission NIHSS, mRS, and GCS on inpatient mortality.

Results

125 participants were enrolled: 61% female, mean age 60+/-16 years, 54% ischemic stroke. Thirty-eight (30%) had PSAP, and 32 (25%) had possible PSAP. Swallow screening was documented for only 4 participants. Participants with PSAP were older (67.7 vs 56.1 years, p<0.001), and on admission had higher NIHSS (25.9 vs 16.7, p<0.001), lower GCS (8.1 vs 12.1, p<0.001), and higher mRS (4.96 vs 4.32, p<0.001). PSAP predicted increased inpatient mortality (PSAP 59%, possible PSAP 39%, no PSAP 8%, p<0.001) independent of age, sex, and initial stroke severity (OR=3.07, 95% CI=1.32-7.15, p=0.009).

Conclusions

PSAP is a frequent complication of acute stroke in Zambia, especially among older participants with more severe presentations. PSAP predicts significantly increased inpatient mortality independent of initial stroke severity, suggesting that interventions mitigating PSAP may improve stroke outcomes in Zambia and other resource-limited settings.

Authors/Disclosures
Morgan Prust, MD (Yale University School of Medicine) PRESENTER	Dr. Prust has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Edelman & Edelman, PC.
Aparna Nutakki, MD	Ms. Nutakki has received research support from UJMT Fogarty Global Health Fellowship Program. Ms. Nutakki has received research support from AAN Medical Student Research Scholarship. Ms. Nutakki has received research support from Gold Humanism Student Summer Fellowship.
	No disclosure on file
Lorraine Chishimba, MBChB, MMED (University Teaching Hospital)	Dr. Chishimba has nothing to disclose.
Mashina Chomba, MBChB (University of Zambia)	Dr. Chomba has nothing to disclose.
Mataa Mataa	No disclosure on file
	No disclosure on file
Stanley Zimba, MBBS (University Teaching Hospital)	Dr. Zimba has nothing to disclose.
Rebecca F. Gottesman, MD (Johns Hopkins University)	Dr. Gottesman has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. The institution of Dr. Gottesman has received research support from NIH.
Mona Bahouth, MD (Johns Hopkins School of Medicine)	The institution of Dr. Bahouth has received research support from American Heart Association. The institution of Dr. Bahouth has received research support from NIH.
Deanna Saylor, MD, MHS (Johns Hopkins Hospital)	The institution of Dr. Saylor has received research support from National Institutes of Health. The institution of Dr. Saylor has received research support from National Multiple Sclerosis Society. The institution of Dr. Saylor has received research support from American Academy of Neurology. The institution of Dr. Saylor has received research support from United States Department of State. Dr. Saylor has a non-compensated relationship as a Member of multiple committees and task forces focused on improving access to MS medications to people across the world with Multiple Sclerosis International Federation that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the Neurology and COVID19 committee with World Health Organization that is relevant to AAN interests or activities. Dr. Saylor has a non-compensated relationship as a Member of the International Outreach Committee, Junior and Early Career Membership Committee, and Educational Innovation Commitees with American Neurological Association that is relevant to AAN interests or activities.