BackgroundSignificant health issues and service delivery costs are associated with post-stroke pneumonia related to dysphagia. Silent aspiration is known to increase pneumonia and mortality in this population. The utility of cough reflex testing (CRT) for reducing pneumonia in acute stroke patients was the subject of this randomised, controlled trial.MethodsPatients referred for swallowing evaluation (N = 311) were assigned to either 1) a control group receiving standard evaluation or 2) an experimental group receiving standard evaluation with CRT. Participants in the experimental group were administered nebulised citric acid with test results contributing to clinical decisions. Outcomes for both groups were measured by pneumonia rates at 3 months post evaluation and other clinical indices of swallowing management.ResultsAnalysis of the data identified no significant differences between groups in pneumonia rate (P = 0.38) or mortality (P = 0.15). Results of CRT were shown to influence diet recommendations (P < 0.0001) and referrals for instrumental assessment (P < 0.0001).ConclusionsDespite differences in clinical management between groups, the end goal of reducing pneumonia in post stroke dysphagia was not achieved.

Significant health issues and service delivery costs are associated with dysphagia following stroke. This prospective cohort study identifies characteristics and outcomes associated with dysphagia secondary to stroke in New Zealand. These data are discussed in reference to data from the National Acute Stroke Services Audit 2009 and published international data. Patients consecutively referred for a swallowing evaluation at four urban hospitals in New Zealand were invited to participate. Characteristics of 311 patients with dysphagia following acute stroke were collected and outcomes were measured at 3 months post stroke. Mortality rates were 16% and pneumonia rates 27%. Mean length of stay was 24 days and only 45% of patients were in their own home at three months post stroke. Pneumonia was significantly associated with mortality (P < 0.0001) and increased length of stay (P < 0.0001). Only 13% of patients received referral for instrumental assessment of swallowing. In conclusion, the outcomes for stroke patients with dysphagia in New Zealand are poor with a high risk of pneumonia and long hospital stays. Multidisciplinary acute stroke service teams need clear clinical pathways to reduce mortality and pneumonia rates for these high-risk patients with dysphagia.

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