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(Stroke. 2006;37:1657.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Response to Letter by Kwan et al

Ángel Chamorro, MD, PhD Martha Vargas, PhD

Stroke Unit, Hospital Clínic, Institut d’ Investigacions Biomédiques, August Pi i Sunyer (IDIBAPS), Barcelona, Spain

José Mensa, MD

Infectious Diseases Unit, Hospital Clínic, Barcelona, Spain

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Response:

We appreciate the interest of Dr Kwan and colleagues in our recent work analyzing the clinical consequences of systemic infection in patients with acute stroke.¹ In their Letter to the Editor these authors request some clarifications about the methods used in the study, and make some criticisms that we pass to address.

Kwan et al demand whether the clinical outcome of the patients was measured at hospital discharge or at day 7, and how the clinical score was handled in patients discharged before day 7. We agree that a variable time-point for the evaluation of the patients would have biased the results of the study. Thus, patients with a protracted outcome score would have been allowed more time for recovery than patients with shorter observations, but also to longer exposure to invasive maneuvers and secondary risk of infection. To avoid this heterogeneity we did all outcome assessments at day 7, except in patients with stable symptoms for at least 48 hours, who were discharged before day 7. The Last Observation Carried Forward approach was the method selected for analysis in these cases. Therefore, we are confident that we did not introduce an attrition bias in our clinical evaluation.

Kwan and colleagues criticize the nonspecific definition of acute bronchitis used in the study, and the inclusion of acute bronchitis as an end point for it might minimize the relevance of infection because its systemic impact might not be as great as that of bacterial pneumonia. Nevertheless, we established a quite . . . [Full Text of this Article]

Related Article:

Do We Really Understand the Pathophysiology and Clinical Impact of Poststroke Infection?

Joseph Kwan, Helen C. Roberts, and Nicola Englyst
Stroke 2006 37: 1656. [Extract] [Full Text] [PDF]

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