Can’t swallow, can’t transfer, can’t toilet: Factors predicting infections in the first week post stroke

Brogan, Emily; Langdon, Claire; Brookes, Kim; Budgeon, Charley; Blacker, David

doi:10.1016/j.jocn.2014.05.035

Cited by 27 publications

(36 citation statements)

References 26 publications

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“…Kalra et al [31] and Kalra et al [32] used the same RCT data. Study designs included RCTs (30%) [15,[31][32][33], prospective (20%) [13,34] and retrospective (40%) [35][36][37][38] observational studies and one quasi-experimental design [39]. Europe hosted 55% of studies [15,[31][32][33][34]37], Australia 27% [13,36,38] and Japan 18% [35,39].…”

Section: Resultsmentioning

confidence: 99%

“…Four studies reported pneumonia during hospitalization [33,34,37,39]. Three studies reported within 14 days of admission [31,32,35] and one from 7 days of admission [36]. Warusevitaine et al [15] and Langdon et al [13] reported at 21 days and 30 days, respectively.…”

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 99%

“…Four used a combination of clinical symptoms, radiologic findings on X-ray and laboratory results and combined antibiotics [13,15,33,37]. Two studies provided no definition [36,38].…”

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 99%

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Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

et al. 2019

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Dysphagia is associated with increased risk of stroke-associated pneumonia (SAP). However, it is unclear what other factors contribute to that risk or which measures may reduce it. This systematic review aimed to provide evidence on interventions and care processes associated with SAP in patients with dysphagia. Studies were screened for inclusion if they included dysphagia only patients, dysphagia and non-dysphagia patients or unselected patients that included dysphagic patients and evaluated factors associated with a recorded frequency of SAP. Electronic databases were searched from inception to February 2017. Eligible studies were critically appraised. Heterogeneity was evaluated using I 2. The primary outcome was SAP. Eleven studies were included. Sample sizes ranged from 60 to 1088 patients. There was heterogeneity in study design. Measures of immunodepression are associated with SAP in dysphagic patients. There is insufficient evidence to justify screening for aerobic Gram-negative bacteria. Prophylactic antibiotics did not prevent SAP and proton pump inhibitors may increase risk. Treatment with metoclopramide may reduce SAP risk. Evidence that nasogastric tube (NGT) placement increases risk of SAP is equivocal. A multidisciplinary team approach and instrumental assessment of swallowing may reduce risk of pneumonia. Patients with impaired mobility were associated with increased risk. Findings should be interpreted with caution given the number of studies, heterogeneity and descriptive analyses. Several medical interventions and care processes, which may reduce risk of SAP in patients with dysphagia, have been identified. Further research is needed to evaluate the role of these interventions and care processes in clinical practice.

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Section: Resultsmentioning

confidence: 99%

Section: Diagnosis and Frequency Of Sapmentioning

confidence: 99%

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Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

et al. 2019

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“…The potential for tube feeding to contribute to infection by promoting oral-pharyngeal colonisation or aspiration, and other factors such as poor oral and dental hygiene, requiring assistance with mobility, positioning, and concurrent chest and cardiac disease, have been identified as potential risk factors for SAP [45,46]. Further research about the association between these factors and dysphagia patients developing SAP would improve our understanding of their impact during the first 72 h of admission and potentially improve patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

Impact of Dysphagia Assessment and Management on Risk of Stroke-Associated Pneumonia: A Systematic Review

et al. 2018

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Background: Patients with dysphagia are at an increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed during the acute phase. The aim of this review was to identify the methods of assessment and management in acute stroke that influence the risk of stroke-associated pneumonia. Studies of stroke patients that reported dysphagia screening, assessment or management and occurrence of pneumonia during acute phase stroke were screened for inclusion after electronic searches of multiple databases from inception to November 2016. The primary outcome was association with stroke-associated pneumonia. Summary: Twelve studies of 87,824 patients were included. The type of dysphagia screening protocol varied widely across and within studies. There was limited information on what comprised a specialist swallow assessment and alternative feeding was the only management strategy, which was reported for association with stroke-associated pneumonia. Use of a formal screening protocol and early dysphagia screening (EDS) and assessment by a speech and language pathologist (SLP) were associated with a reduced risk of stroke-associated pneumonia. There was marked heterogeneity between the included studies, which precluded meta-analysis. Key Messages: There is variation in the assessment and management of dysphagia in acute stroke. There is increasing evidence that EDS and specialist swallow assessment by an SLP may reduce the odds of stroke-associated pneumonia. There is the potential for other factors to influence the incidence of stroke-associated pneumonia during the acute phase.

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“…[7,19] The link between UI and death is probably complex and not explained solely by indwelling catheter placement. UI increases the risk of infection [20,21], falls, fall related injuries [22], and malnutrition [23], factors which contribute to the increased mortality. Mortality among incontinent patients or patients with IUC could reflect the severity of strokes -severely impaired patients have higher risk of becoming incontinent and an IUC is often warranted in order to monitor urine output.…”

Section: Discussionmentioning

confidence: 99%

Urinary Incontinence and Indwelling Urinary Catheters as Predictors of Death after New-Onset Stroke: A Report of the South London Stroke Register

John

Primmaz

Crichton

et al. 2018

Journal of Stroke and Cerebrovascular Diseases

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Can’t swallow, can’t transfer, can’t toilet: Factors predicting infections in the first week post stroke

Cited by 27 publications

References 26 publications

Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review

Impact of Dysphagia Assessment and Management on Risk of Stroke-Associated Pneumonia: A Systematic Review

Urinary Incontinence and Indwelling Urinary Catheters as Predictors of Death after New-Onset Stroke: A Report of the South London Stroke Register

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