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

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

doi:10.1159/000492730

Cited by 99 publications

(120 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Patients with dysphagia are more than three times at risk of developing pneumonia after stroke and the risk increases 11-fold in patients with confirmed aspiration [11]. Early dysphagia screening and specialist swallow assessment by a speech and language pathologist (SLP) may reduce the risk of SAP [12]. However, patients who are exclusively fed via the enteral route are also at risk of developing SAP.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2019

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Introductionmentioning

confidence: 99%

“…However, these risk factors are outside the scope of this review. For this review, factors were defined as medical interventions to manage physiological status and care processes systemic to patients with dysphagia, in acute phase stroke and were identified from references and citation searching from a precursory systematic review [12].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…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%

“…The type of dysphagia screening protocol (DSP) used varies widely and there is limited information about the components of the specialist swallow assessment [11]. Screening protocols can vary from informal screens to validated protocols that assess with water only [12,13] and stepwise screens that provide separate evaluations for non-fluids and fluids [14].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…

In this journal, S.A. Eltringham et al from the UnitedKingdom [1] systematically reviewed the methods of assessment and management in patients with acute stroke that influence the risk of stroke-associated pneumonia. Twelve studies of 87,824 patients were included.

…”

mentioning

confidence: 99%

Coincidence and Management of Non-Motor Stroke-Associated Risks (Dysphagia – Swallowing Deficits – Visual Neglect)

Hennerici¹

2018

Cerebrovasc Dis

View full text Add to dashboard Cite

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

Cited by 99 publications

References 39 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

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

Coincidence and Management of Non-Motor Stroke-Associated Risks (Dysphagia – Swallowing Deficits – Visual Neglect)

Contact Info

Product

Resources

About