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

Abstract

Background and purposeGuidelines recommend dysphagia screening to identify those at high risk of pneumonia. However, little is known about the prevalence and predictors of dysphagia screening and pneumonia among patients with acute ischaemic stroke in China.MethodsUsing data from the Chinese Stroke Center Alliance, which is a multicentre, prospective, consecutive patient enrolment programme, univariate and multivariate analyses were conducted to identify patient and hospital characteristics associated with dysphagia screening and pneumonia during acute hospitalisation.ResultsOf 790 811 patients admitted to 1476 hospitals, 622 718 (78.7%) underwent dysphagia screening, and 64 398 (8.1%) developed pneumonia. Patients in stroke units were more likely to be screened for dysphagia than those not in stroke units (OR 1.50; 95% CI 1.48 to 1.52), while patients with a past history of stroke were less likely to be screened (OR 0.87; 95% CI 0.86 to 0.88). Dysphagia screening (OR 1.46; 95% CI 1.30 to 1.65), dysphagia (OR 7.31; 95% CI 7.15 to 7.46), and admission to stroke units (OR 1.17; 95% CI 1.14 to 1.19) were significantly associated with a greater risk of pneumonia.ConclusionsDysphagia was a critical factor in the development of pneumonia. Nearly one in five patients with acute ischaemic stroke in the Chinese Stroke Center Alliance were not screened for dysphagia. Pneumonia prevention during acute hospitalisation is dependent not only on dysphagia screening but also on the effectiveness of subsequent dysphagia management interventions. Further studies are needed to elucidate the relationship between dysphagia screening, stroke unit care and pneumonia in patients with acute ischaemic stroke.

Predictive Ability of Systemic Inflammation Response Index for the Risk of Pneumonia in Patients with Acute Ischemic Stroke

“…Moreover, multivariate regression analysis indicated that dysphagia severity was also a significant risk factor for the occurrence of pneumonia in AIS patients, which was consistent with previous findings [37, 38]. Dysphagia occurs in more than 70% of stroke patients [39]. Because swallowing ability and respiratory function share the aerodigestive tract physiologically, reduced laryngopharyngeal sensation and an impaired cough reflex can easily lead to aspiration [40].…”

Costs of post-stroke dysphagia during acute hospitalization from a health-insurance perspective

“…8 Swallowing impairment not only represents a major psychological burden for patients, but also leads to serious complications. In particular, aspiration pneumonia 11 and malnutrition 12 may occur as a result of dysphagia, worsening functional outcomes and contributing to premature mortality. 13 Dysphagia is not always noticed by patients, and silent aspiration may be present that is not apparent on clinical examination.…”

Adherence to Stroke Care Performance Measures in Different Regions in China, 2015–2019

“…We think the lower adherence rate in the belt regions is possibly because of the higher percentage of patients with stroke history and lower percentage of stroke units equipped, which is consistent with the existing literature. [18][19][20] To better mitigate the difference, we suggest to increase the awareness of the guideline-recommended treatments and the percentage of the capable stroke units in the belt regions.…”