Introduction Hospital Acquired Question & Answer Guide (With Explanation)
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Original Question
Introduction: Hospital-acquired infections (HAIs) after stroke are associated with additional morbidity and mortality, but whether HAIs increase long-term cognitive decline in stroke patients is unknown. We hypothesized that older adults with incident stroke with HAI experience faster cognitive decline than those having stroke without HAI and those without stroke. Methods: We performed a longitudinal analysis in the population-based prospective Cardiovascular Health Study. Medicare-eligible participants aged ≥65 years with and without incident stroke had cognition assessed annually. HAIs were assessed by hospital discharge codes. Global cognitive function was assessed annually by the Modified Mini-Mental State Examination (3MSE) and executive function by the Digit Symbol Substitution Test (DSST). We used linear mixed models to estimate the mean decline and 95% confidence intervals (95% CI) for 3MSE and DSST scores by incident stroke and HAI status, adjusted for demographics and vascular risk factors. Results: Among 5,443 participants ≥65 years without previous history of stroke, 393 participants had stroke with HAI (SI), 766 had a stroke only (SO), and 4,284 had no stroke (NS) throughout a maximum 9-year follow-up. For 3MSE, compared with NS participants, SO participants had a similar adjusted mean decline (additional 0.08 points/year, 95% CI: −0.15, 0.31), while SI participants had a more rapid decline (additional 0.28 points/year, 95% CI: 0.16, 0.40). Adjusted mean decline was 0.20 points/year faster (95% CI: −0.05, 0.45) among SI than SO participants. For DSST, compared with NS participants, SO participants had a faster adjusted mean decline (additional 0.17 points/year [95% CI: 0.003, 0.33]), as did SI participants (additional 0.27 points/year [95% CI: 0.19, 0.35]). Conclusion: Stroke, when accompanied by HAI, leads to a faster long-term decline in cognitive ability than in those without stroke. The clinical and public health implications of the effect of infection on post-stroke cognitive decline warrant further attention. [ABSTRACT FROM AUTHOR]Copyright of Cerebrovascular Diseases is the property of Karger AG and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)Author Affiliations:1School of Medicine, University of Utah, Salt Lake City, Utah, USA 2Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA 3Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA 4Department of Public Health, Brigham Young University, Provo, Utah, USA 5Departments of Neurology and Epidemiology, University of Washington, Seattle, Washington, USA 6Department of Psychology and the Neuroscience Center, Brigham Young University, Provo, Utah, USAFull Text Word Count:5614ISSN:1015-9770DOI:10.1159/000533568Accession Number:178911136Database:Academic Search Complete Please use the article above to answer the question show below in the chart, Thanks Article number Author, date, and title Type of evidence Population, size, and setting Intervention Findings that help answer the EBP question Measures used Limitations Evidence level and quality
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