Development and implementation of acute stroke care pathway in a tertiary care hospital in India: A cluster-randomized study

Rai, Neha; Prasad, Kameshwar; Bhatia, Rohit; Vibha, Deepti; Singh, Mamta Bhushan; Vinod, Kutty Sharada; Kumar, Amit

doi:10.4103/0028-3886.178038

Cited by 12 publications

(10 citation statements)

References 2 publications

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“…15 The stroke care pathway included a local institutionally developed swallow screen consisting of assessments of level of consciousness, strength of the patient's voice and cough, and ability to swallow sips of water and the local softtexture foods khichri, kheer, or payasam (Kameshwar Prasad, MD, DM, MSc, written communication, September 12, 2017). The swallow screen was administered by a resident physician.…”

Section: Resultsmentioning

confidence: 99%

“…15 Because of the limited data available, no conclusions can be drawn about the clinical effectiveness of dysphagia screening protocols. 12 *Judged to be at high risk of bias because of a baseline imbalance in the proportion of hemorrhagic stroke patients, with a higher frequency of hemorrhagic stroke admissions to the ward randomized to usual care.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] Interpretation of 2 of the trials, including the largest highest-quality trial, 13 was confounded by other concurrent quality improvement interventions. 13,15 One trial showed no difference in the rates of pneumonia in patients randomized to receive the cough reflex test.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Smith¹,

Kent²,

Bulsara³

et al. 2018

Stroke

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Introduction— Dysphagia screening protocols have been recommended to identify patients at risk for aspiration. The American Heart Association convened an evidence review committee to systematically review evidence for the effectiveness of dysphagia screening protocols to reduce the risk of pneumonia, death, or dependency after stroke. Methods— The Medline, Embase, and Cochrane databases were searched on November 1, 2016, to identify randomized controlled trials (RCTs) comparing dysphagia screening protocols or quality interventions with increased dysphagia screening rates and reporting outcomes of pneumonia, death, or dependency. Results— Three RCTs were identified. One RCT found that a combined nursing quality improvement intervention targeting fever and glucose management and dysphagia screening reduced death and dependency but without reducing the pneumonia rate. Another RCT failed to find evidence that pneumonia rates were reduced by adding the cough reflex to routine dysphagia screening. A smaller RCT randomly assigned 2 hospital wards to a stroke care pathway including dysphagia screening or regular care and found that patients on the stroke care pathway were less likely to require intubation and mechanical ventilation; however, the study was small and at risk for bias. Conclusions— There were insufficient RCT data to determine the effect of dysphagia screening protocols on reducing the rates of pneumonia, death, or dependency after stroke. Additional trials are needed to compare the validity, feasibility, and clinical effectiveness of different screening methods for dysphagia.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Smith¹,

Kent²,

Bulsara³

et al. 2018

Stroke

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“…Across the included studies, the number of participants sampled per study ranged from 16 participants 20 to 486 participants 17 . Age related data was only reported by Sreeraj et al 17 (18 to 90 years) study, and the other studies 18-20 did not report any data with respect to age of the participants. Sex distribution of the participants was not clearly described in any of the four studies.…”

Section: Resultsmentioning

confidence: 92%

“…The food consistency used to assess swallow varied with most studies. The study by Rai et al 18 used ‘Khichri/Kheer’ (based on the North Indian diet), or Payasam (based on the South Indian diet), which they describe as equivalents of the western puree thick consistency. Sundar et al 19 used liquid thin consistency (50 ml water) only.…”

Section: Resultsmentioning

confidence: 99%

Dysphagia and associated pneumonia in stroke patients from India

Krishnamurthy

Premkumar

Balasubramanium

2020

Preprint

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Background: India has high incidence (116-163 per 100,000) of stroke compared to western countries. Stroke is reported to be the fourth leading cause of death and fifth leading cause of disability in India. Dysphagia is seen approximately in half of the stroke patients and if unidentified may result in pulmonary complications such as aspiration pneumonia. However, there is no estimate of post stroke dysphagia and associated pneumonia in India. Method: Using the PRISMA methodology, a systematic search for recent literature on dysphagia in stroke was carried out across all the major databases. Two authors independently screened the titles and the abstracts, and those selected articles were assessed for quality using the GRADE approach. Comparisons were made of reported dysphagia and pneumonia frequencies, the relative risks of developing pneumonia were calculated. Data on duration of hospital stay and rates of mortality were also extracted. Results: We identified 86 citations, out of which only four articles were deemed eligible for critical analyses and data extraction. A high incidence (11.1% - 87.5%) of dysphagia was observed among stroke patients. Only two studies reported on incidence of pneumonia (22.8% - 32%); only one study stratified patients by both dysphagia and pneumonia. A relative risk of 5.82 (95% CI 4.6, 7.2) was found for pneumonia in patients with stroke and dysphagia. Data on length of hospital stay and rates of mortality secondary to aspiration pneumonia are also presented. Conclusion: Despite high incidence of dysphagia and associated pneumonia the methodological quality of studies are low. There is a dire need for methodologically sound studies to accurate determine the incidence of dysphagia and its impact on stroke patients in India. Keywords: deglutition; deglutition disorders; dysphagia; stroke; incidence; india;

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Organised inpatient (stroke unit) care for stroke: network meta-analysis

Langhorne

Ramachandra

2020

Cochrane Database of Systematic Reviews

211

213

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Development and implementation of acute stroke care pathway in a tertiary care hospital in India: A cluster-randomized study

Abstract: Stroke CPs reduce the incidence of aspiration pneumonia, the need for mechanical ventilation, and the risk of death, when assessed at a follow-up of 90 days.

Cited by 12 publications

References 2 publications

Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Effect of Dysphagia Screening Strategies on Clinical Outcomes After Stroke: A Systematic Review for the 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke

Dysphagia and associated pneumonia in stroke patients from India

Organised inpatient (stroke unit) care for stroke: network meta-analysis

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