Dysphagia in Patients with Acute Ischemic Stroke: Early Dysphagia Screening May Reduce Stroke-Related Pneumonia and Improve Stroke Outcomes

Abstract

Background: Dysphagia is associated with poor outcome in stroke patients. Studies investigating the association of dysphagia and early dysphagia screening (EDS) with outcomes in patients with acute ischemic stroke (AIS) are rare. The aims of our study are to investigate the association of dysphagia and EDS within 24 h with stroke-related pneumonia and outcomes. Methods: Over a 4.5-year period (starting November 2007), all consecutive AIS patients from 15 hospitals in Schleswig-Holstein, Germany, were prospectively evaluated. The primary outcomes were stroke-related pneumonia during hospitalization, mortality, and disability measured on the modified Rankin Scale ≥2-5, in which 2 indicates an independence/slight disability to 5 severe disability. Results: Of 12,276 patients (mean age 73 ± 13; 49% women), 9,164 patients (74%) underwent dysphagia screening; of these patients, 55, 39, 4.7, and 1.5% of patients had been screened for dysphagia within 3, 3 to <24, 24 to ≤72, and >72 h following admission. Patients who underwent dysphagia screening were likely to be older, more affected on the National Institutes of Health Stroke Scale score, and to have higher rates of neurological symptoms and risk factors than patients who were not screened. A total of 3,083 patients (25.1%; 95% CI 24.4-25.8) had dysphagia. The frequency of dysphagia was higher in patients who had undergone dysphagia screening than in those who had not (30 vs. 11.1%; p < 0.001). During hospitalization (mean 9 days), 1,271 patients (10.2%; 95% CI 9.7-10.8) suffered from stroke-related pneumonia. Patients with dysphagia had a higher rate of pneumonia than those without dysphagia (29.7 vs. 3.7%; p < 0.001). Logistic regression revealed that dysphagia was associated with increased risk of stroke-related pneumonia (OR 3.4; 95% CI 2.8-4.2; p < 0.001), case fatality during hospitalization (OR 2.8; 95% CI 2.1-3.7; p < 0.001) and disability at discharge (OR 2.0; 95% CI 1.6-2.3; p < 0.001). EDS within 24 h of admission appeared to be associated with decreased risk of stroke-related pneumonia (OR 0.68; 95% CI 0.52-0.89; p = 0.006) and disability at discharge (OR 0.60; 95% CI 0.46-0.77; p < 0.001). Furthermore, dysphagia was independently correlated with an increase in mortality (OR 3.2; 95% CI 2.4-4.2; p < 0.001) and disability (OR 2.3; 95% CI 1.8-3.0; p < 0.001) at 3 months after stroke. The rate of 3-month disability was lower in patients who had received EDS (52 vs. 40.7%; p = 0.003), albeit an association in the logistic regression was not found (OR 0.78; 95% CI 0.51-1.2; p = 0.2). Conclusions: Dysphagia exposes stroke patients to a higher risk of pneumonia, disability, and death, whereas an EDS seems to be associated with reduced risk of stroke-related pneumonia and disability.

The Effect of Improved Dysphagia Care on Outcome in Patients with Acute Stroke: Trends from 8-Year Data of a Large Stroke Register

“…In our study, in-hospital mortality was rather high among dysphagic patients. The risk of death, however, was within the range of previous reports published in the same time period that was covered by our study [5, 9]. In terms of this aspect, we confirm previous findings within our large, unselected patient population.…”

Telehealth Stroke Dysphagia Evaluation Is Safe and Effective

“…In terms of safety, only 2% of patients developed HAP, and after extensive review of the cases, it appeared that both were unrelated to diet. While the sample size for determining HAP was too small to be conclusive, this rate is lower than the 4-44% of stroke-associated pneumonia that has been reported in the literature [2,11]. …”

“…There are 3 major implications for our study compared to previous studies. First, rapid changes in swallowing abilities can take place during poststroke recovery and fast timing is essential to reduce the risk of aspiration pneumonia [1,2]. The majority of our bedside and telehealth evaluations were carried out within an hour of each other.…”

“…Up to 67% of patients who have a stroke develop some degree of dysphagia and early swallow evaluation is crucial to lower their risk of potentially life-threatening aspiration pneumonia [1,2]. Small and remote hospitals are often underserved by speech language pathologists (SLPs) for dysphagia evaluation of acute stroke patients.…”

Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis

“…However, these factors were not evaluated in the present study. A joint multidisciplinary rehabilitation effort, during and after hospitalization, with a focus on early dysphagia screening, improving swallowing and urinary incontinence, and early mobilization, is necessary in these patients to prevent infections and thereby reduce potential causes of death [40,41,42]. Other strategy to reduce the hospital-acquired pneumonia, an important cause of in-hospital death, is the systematic oral care protocols.…”