Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study

Abstract

Background Dysphagia is associated with aspiration pneumonia after stroke. Data are limited on the influences of dysphagia screen and assessment in clinical practice. Aims To determine associations between a “brief” screen and “detailed” assessment of dysphagia on clinical outcomes in acute stroke patients. Methods A prospective cohort study analyzed retrospectively using data from a multicenter, cluster cross-over, randomized controlled trial (Head Positioning in Acute Stroke Trial [HeadPoST]) from 114 hospitals in nine countries. HeadPoST included 11,093 acute stroke patients randomized to lying-flat or sitting-up head positioning. Herein, we report predefined secondary analyses of the association of dysphagia screening and assessment and clinical outcomes of pneumonia and death or disability (modified Rankin scale 3–6) at 90 days. Results Overall, 8784 (79.2%) and 3917 (35.3%) patients were screened and assessed for dysphagia, respectively, but the frequency and timing for each varied widely across regions. Neither use of a screen nor an assessment for dysphagia was associated with the outcomes, but their results were compared to “screen-pass” patients, those who failed had higher risks of pneumonia (adjusted odds ratio [aOR] = 3.00, 95% confidence interval [CI] = 2.18–4.10) and death or disability (aOR = 1.66, 95% CI = 1.41–1.95). Similar results were evidence for the results of an assessment for dysphagia. Subsequent feeding restrictions were related to higher risk of pneumonia in patients failed dysphagia screen or assessment (aOR = 4.06, 95% CI = 1.72–9.54). Conclusions Failing a dysphagia screen is associated with increased risks of pneumonia and poor clinical outcome after acute stroke. Further studies concentrate on determining the effective subsequent feeding actions are needed to improve patient outcomes.

Predictors of dysphagia screening and pneumonia among patients with acute ischaemic stroke in China: findings from the Chinese Stroke Center Alliance (CSCA)

“…20 21 In the HeadPoST programme, a multinational study conducted between March 2015 and November 2016, the frequency of DS was found to be 69.2% in China. 8 Adherence to DS was improved because the CSCA provided an opportunity to increase adherence to evidence-based practices, and DS is widely carried out in hospitals nationwide. However, one in five patients with AIS were still not screened.…”

Capsaicin combined with ice stimulation improves swallowing function in patients with dysphagia after stroke: A randomised controlled trial

“…Dysphagia is a common condition after a stroke and can cause serious complications, including malnutrition, aspiration pneumonia and premature death 5,6 . Although dysphagia is prevalent in the elderly and is accompanied by severe complications, dysphagia is often overlooked and underdiagnosed in the populations of vulnerable patient 7 . It has been reported that dysphagia accounts for 8.1%‐80% in the patients with stroke 8 .…”

An Overview of Systematic Reviews and Meta-Analyses on Acupuncture for Post-Acute Stroke Dysphagia

“…Screening methods cannot work alone, it depends on the accuracy and reliability of the equipment and the experience of doctors, but there is still a need to integrate care management approaches [6]. Increased risk of pneumonia following post-acute stroke dysphagia may be associated with failures in dysphagia screening after an acute stroke [7], suggesting potentially further increased costs.…”