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

Eltringham, Sabrina A.; Kilner, Karen; Gee, Melanie; Sage, Karen; Bray, Benjamin; Smith, Craig J.; Pownall, Sue

doi:10.1007/s00455-019-10061-6

Cited by 62 publications

(61 citation statements)

References 39 publications

(152 reference statements)

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“…This study forms part of a series of studies [11][12][13] that aim to investigate how variation in assessment and management of dysphagia in acute stroke affects development of SAP. The aim of this interview study is to explore the experiences of people with swallowing difficulties following a stroke to give a more rounded picture of delivery of care and ensure that the perspectives of stroke survivors and their informal caregivers are included.…”

Section: Aims Of the Studymentioning

confidence: 99%

“…In the United Kingdom, guidelines [10] recommend people with a stroke are screened for dysphagia within 4 h of admission to hospital and, if dysphagia is suspected, a comprehensive swallow assessment, usually carried out by a SLP, is undertaken within 72 h. A wide range of dysphagia screening protocols (DSPs) are used to screen people and there is limited information about what comprises a specialist swallow assessment [11]. A range of medical interventions and clinical processes may also be associated with risk of SAP in people with swallowing difficulties [12].…”

Section: Introductionmentioning

confidence: 99%

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Experiences of Dysphagia after Stroke: An Interview Study of Stroke Survivors and Their Informal Caregivers

et al. 2019

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(1) Background: Swallowing difficulties (dysphagia) after stroke are not uncommon and is a consistent risk factor for stroke-associated pneumonia. This interview study explores the perspectives of stroke survivors, who had their swallowing assessed in the first few days of admission to hospital, and their informal caregivers. (2) Methods: A participatory approach was used involving people affected by stroke in the interpretation and analysis of the interview data. Data was thematically analysed and six themes were identified. (3) Results: These themes included how past-future experiences may influence a person’s emotional response to events; understanding what is happening and adjustment; the impact of dysphagia; attitudes to care; communication to patients and procedural issues. (4) Conclusion: The findings highlight the importance of effective public health messages to improve people’s responsiveness to the signs of stroke, standardisation of assessment and management procedures, effective communication to patients about the consequences of dysphagia, and the impact of dysphagia on the person who had the stroke and their informal caregiver.

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Section: Aims Of the Studymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Experiences of Dysphagia after Stroke: An Interview Study of Stroke Survivors and Their Informal Caregivers

et al. 2019

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“…This study found that SAP may be the leading risk factor for abnormal oral hygiene in patients with acute ischemic stroke, although the exact reason is not clear. Surprisingly, the BOAS score was an independent risk factor for SAP, suggesting that abnormal oral hygiene has a higher risk coe cient than swallowing disorders, which is different from previous studies [8,9]. Combined with two multiple regression analyses, we determined that oral hygiene abnormalities and SAP interact with each other and that this interaction may form a vicious cycle (Fig.…”

Section: Discussionmentioning

confidence: 58%

“…Various mechanisms underlying the development of SAP have been identi ed, in addition to stroke-induced immunosuppression, dysphagia, poor respiratory muscle strength, decreased pulmonary function and respiratory center dysfunction after brain injury also play important roles [5][6][7][8][9][10]. Among them, oral hygiene is often overlooked.…”

Section: Introductionmentioning

confidence: 99%

Mutually Risk Roles of Oral Cleanliness and Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke: A Cross-Sectional Study

Yang

Chen

Yang

et al. 2020

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Background: Stroke-associated pneumonia (SAP) is a major complication after stroke, oral microorganisms are important contributors to SAP. Here, we aimed to investigate whether the oral hygiene was associated with SAP and related risk factors of them in patients with acute ischemic stroke. Methods: We performed a cross-sectional study that recruited 331 patients with acute ischemic stroke from two medical centers. A series of assessments were performed to evaluate the neurological status and habits of oral hygiene. According to whether the oral hygiene was abnormal and SAP occurred, univariate analyses were performed in cohort 1 (normal / abnormal oral hygiene groups) and cohort 2 (SAP / non-SAP groups). Multiple logistic regression analyses were conducted to confirm risk factors of oral cleanliness and SAP in stroke patients. Results: A total of 12 and 8 independent variables were included in the model 1 and 2 analysis. After adjusting for confounders, multivariable logistic regression analysis showed that oral cleanliness was not only closely related to SAP (OR=2.219, P=0.026), dental caries (OR=1.292, P=0.005) and age (OR=1.030, P=0.006) in model 1, but also an independent risk factor for predicting SAP (OR=1.678, P=0.001) in model 2. Barthel index was a protective factor for oral cleanliness (OR=0.986, P=0.019) and SAP (OR=0.977, P=0.002) in ischemic stroke patients. Conclusions: Mutually primary risk roles of abnormal oral cleanliness and SAP exist in patients with acute ischemic stroke. Dental caries and aging are important risk factors for oral health disorders. Improving the activities of daily living would have protective effects on both oral hygiene and SAP prevention in stroke patients.

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“…Interviews were conducted between 27 April 2018-14 September 2018 by the primary author and recorded using an Olympus WS-853 digital voice recorder. The topic guide was developed based on themes emerging from the literature [11,22]. Questions were grouped by professional relevance.…”

Section: Methodsmentioning

confidence: 99%

Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study

et al. 2019

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1) Background: Patients with dysphagia are at increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed. The aim of this study is to explore staff opinions about current practice of dysphagia screening, assessment and clinical management in acute phase stroke. (2) Methods: Fifteen interviews were conducted in five English National Health Service hospitals. Hospitals were selected based on size and performance against national targets for dysphagia screening and assessment, and prevalence of stroke-associated pneumonia. Participants were purposefully recruited to reflect a range of healthcare professions. Data were analysed using a six-stage thematic process. (3) Results: Three meta themes were identified: delays in care, lack of standardisation and variability in resources. Patient, staff, and service factors that contribute to delays in dysphagia screening, assessment by a speech and language therapist, and delays in nasogastric tube feeding were identified. These included admission route, perceived lack of ownership for screening patients, prioritisation of assessments and staff resources. There was a lack of standardisation of dysphagia screening protocols and oral care. There was variability in staff competences and resources to assess patients, types of medical interventions, and care processes. (4) Conclusion: There is a lack of standardisation in the way patients are assessed for dysphagia and variation in practice relating to staff competences, resources and care processes between hospitals. A range of patient, staff and service factors have the potential to impact on stroke patients being assessed within the recommended national guidelines.

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

Cited by 62 publications

References 39 publications

Experiences of Dysphagia after Stroke: An Interview Study of Stroke Survivors and Their Informal Caregivers

Experiences of Dysphagia after Stroke: An Interview Study of Stroke Survivors and Their Informal Caregivers

Mutually Risk Roles of Oral Cleanliness and Stroke-associated Pneumonia in Patients with Acute Ischemic Stroke: A Cross-Sectional Study

Variation in Dysphagia Assessment and Management in Acute Stroke: An Interview Study

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