{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:21:16Z","timestamp":1792790476945,"version":"4.5.0"},"reference-count":25,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T00:00:00Z","timestamp":1765411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Neurol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stroke-associated pneumonia (SAP) significantly impacts mortality and functional outcomes in acute stroke care. While multiple risk prediction scores have been developed internationally, their performance in Japanese healthcare settings\u2014characterized by high nurse-to-patient ratios and systematic multidisciplinary protocols\u2014remains unexplored. This study aimed to determine SAP incidence in Japanese acute stroke care and validate established risk prediction scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We conducted a retrospective cohort study of consecutive patients with first-ever acute stroke admitted within 7 days of onset to a 199-bed acute care hospital with a dedicated 24-bed stroke care unit (April 2022\u2013March 2023). SAP was diagnosed using modified CDC criteria requiring radiographic evidence. Three validated risk scores (A\n                      <jats:sup>2<\/jats:sup>\n                      DS\n                      <jats:sup>2<\/jats:sup>\n                      , Pneumonia score, ISAN) were calculated and compared using receiver operating characteristic analysis. Independent predictors were identified through multivariable logistic regression using directed acyclic graph-based variable selection.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 847 patients analyzed (median age 75 years, 54.2% male), SAP developed in 22 patients (2.6%, 95% CI 1.5\u20133.7). Most cases (77.3%) occurred within 72\u00a0h. All three scores demonstrated good discrimination: A\n                      <jats:sup>2<\/jats:sup>\n                      DS\n                      <jats:sup>2<\/jats:sup>\n                      achieved the highest AUROC of 0.825 (95% CI 0.78\u20130.88), followed by Pneumonia score and ISAN (both AUROC 0.798). No statistically significant differences were observed between scores. An A\n                      <jats:sup>2<\/jats:sup>\n                      DS\n                      <jats:sup>2<\/jats:sup>\n                      cutoff\u2009\u2265\u20096 provided optimal balance (sensitivity 86.4%, specificity 65.8%, NPV 99.5%). Independent predictors included male sex (OR 3.87, 95% CI 1.41\u201310.61), NIHSS score (OR 1.08 per point, 95% CI 1.03\u20131.12), dysphagia (OR 5.31, 95% CI 1.16\u201324.34), and mechanical ventilation (OR 5.33, 95% CI 1.28\u201322.18).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      SAP incidence in Japanese acute stroke care (2.6%) was substantially lower than international reports, likely reflecting high nursing standards and systematic preventive protocols. Despite low baseline risk, the A\n                      <jats:sup>2<\/jats:sup>\n                      DS\n                      <jats:sup>2<\/jats:sup>\n                      score demonstrated excellent discrimination and high negative predictive value, enabling reliable risk stratification. The predominance of early SAP onset supports intensive monitoring during the critical first 72\u00a0h. These findings support implementation of A\n                      <jats:sup>2<\/jats:sup>\n                      DS\n                      <jats:sup>2<\/jats:sup>\n                      -based risk stratification protocols in Japanese stroke care settings.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12883-025-04523-8","type":"journal-article","created":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T13:04:31Z","timestamp":1765458271000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Stroke-associated pneumonia in Japanese acute care settings: incidence and preliminary validation of risk prediction scores"],"prefix":"10.1186","volume":"25","author":[{"given":"Hiroki","family":"Kimura","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rika","family":"Hasegawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromi","family":"Oku","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,12,11]]},"reference":[{"issue":"8","key":"4523_CR1","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1161\/STROKEAHA.115.009617","volume":"46","author":"CJ Smith","year":"2015","unstructured":"Smith CJ, Kishore AK, Vail A, Chamorro A, Garau J, Hopkins SJ, et al. 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Given the retrospective nature of this study and the use of data obtained during routine clinical practice, the Ethics Committee granted a waiver of additional study-specific informed consent in accordance with the Japanese Ethical Guidelines for Medical and Health Research Involving Human Subjects. Patient confidentiality and privacy were maintained through data anonymization.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"499"}}