Background
Stroke is a serious vascular emergency which is common and significantly debilitating. In England and Wales alone, it accounted for 11% of all deaths in 1999 [1]. The annual incidence of stroke is 110,000 with more than 900,000 living with the effects of stroke. This national health burden is compounded by the significant dependency of these patients. Data from the National Audit Office Report estimated stroke's cost to society being £7 billion annually with major expenditure from direct healthcare costs (£2.8 billion) being primarily from diagnosis and inpatient care [1].
Stroke is a focal or global disturbance of cerebral function greater than 24 hours or leading to death with an apparent vascular cause [World Health Organization, 2008]. An extension of this clinical syndrome includes various post-stroke complications including mood disturbances, falls, chronic pain, venous thromobembolism and infection – especially urinary infections and pneumonia [2]. Pneumonia is the commonest infection being reported as up to 30% - half of which occur within 48 hours and most developing within a week [3]. A large cohort study found pneumonia being associated with a relative risk of 3.0 for mortality when adjusted for stroke severity [4]. Given significant mortality and morbidity associated with this pulmonary complication, prophylactic management has been the subject of relative interest in the literature as medical complications rates dictate prognosis.