The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia

Bray, Benjamin; Smith, Craig J.; Cloud, Geoffrey; Enderby, Pam; James, Martin; Paley, Lizz; Tyrrell, Pippa J.; Wolfe, Charles; Rudd, Anthony

doi:10.1136/jnnp-2016-313356

Cited by 155 publications

(160 citation statements)

References 21 publications

Supporting

Mentioning

149

Contrasting

Unclassified

Order By: Relevance

“…As a further ray of hope, 2 recent prospective, large, multicenter studies with positive results were published: one found early dysphagia screening to be associated with reduced risk of stroke-related pneumonia and disability [9]. The other reported pneumonia incidence to increase 1% per day of delay in dysphagia screening and comprehensive assessment by an SLT [11]. …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2018

View full text Add to dashboard Cite

Background: Early dysphagia screening and appropriate management are recommended by current guidelines to reduce complications and case fatality in acute stroke. However, data on the potential benefit of changes in dysphagia care on patient outcome are limited. Our objective was to assess the degree of implementation of dysphagia guidelines and determine the impact of modifications in dysphagia screening and treatment practices on disease complications and outcome in stroke patients over time. Methods: In this prospective register-based study (“Stroke Register of Northwestern Germany”), all adult stroke patients admitted to 157 participating hospitals between January, 2008 and December, 2015 were included (n = 674,423). Dysphagia incidence upon admission, the proportion of patients receiving a standardized swallowing screening, and the percentage of dysphagic patients being referred to a speech language therapist (SLT) for treatment were obtained per year. Pneumonia rate, modified Rankin Scale (mRS) at discharge, and in-hospital mortality were compared between groups of dysphagic vs. non-dysphagic patients over time. Results: Screening proportions continuously increased from 47.2% in 2008 to 86.6% in 2015. But the proportion diagnosed with dysphagia remained stable with about 19%. The number of dysphagic patients receiving SLT treatment grew from 81.6 up to 87.0%. Pneumonia incidence was higher in dysphagic stroke cases (adjusted OR 5.4 [5.2–5.5], p < 0.001), accompanied by a worse mRS at discharge (adjusted OR for mRS ≥3: 3.1 [3.0–3.1], p < 0.001) and higher mortality (adjusted OR 3.1 [3.0–3.2], p < 0.001). The order of magnitude of these end points did not change over time. Conclusion: Although advances have been made in dysphagia care, prevalent screening and treatment practices remain insufficient to reduce pneumonia rate, improve functional outcome, and decrease case fatality in dysphagic stroke patients. More research is urgently needed to develop more effective swallowing therapies.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Early dysphagia screening and appropriate management including high-intensity treatment may reduce complications, lead to a more favorable outcome, and lower case fatality [7-11]. Current treatment guidelines for acute stroke care, for example, in Germany, take these study results into account and make respective recommendations [12].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Díaz-Navarro et al [1] found that the presence of dysphagia in patients with acute stroke on hospital admission is an independent predictor of short-term outcome from stroke. Early identification of dysphagia reduces the risk of aspiration, malnutrition, dehydration, aspiration pneumonia, and choking [2, 3]. There is some evidence to suggest that a dysphagia screening protocol is associated with lower rates of pneumonia [3, 4] and, when combined with an acute stroke team protocol, has potential to significantly decrease costs to health services by reducing length of hospital stay and antibiotic treatment [4, 5].…”

Section: Introductionmentioning

confidence: 99%

“…Early identification of dysphagia reduces the risk of aspiration, malnutrition, dehydration, aspiration pneumonia, and choking [2, 3]. There is some evidence to suggest that a dysphagia screening protocol is associated with lower rates of pneumonia [3, 4] and, when combined with an acute stroke team protocol, has potential to significantly decrease costs to health services by reducing length of hospital stay and antibiotic treatment [4, 5]. However, although there is a predominant focus on swallow screening in stroke in the literature, screening for dysphagia is important in all high-risk populations such as dementia, head and neck cancer, pulmonary disease, Parkinson’s disease, and critical illness [6].…”

Section: Introductionmentioning

confidence: 99%

Screening for Dysphagia: Perspectives and Practices of Speech and Language Therapists in the Republic of Ireland

Walshe

Ryan

Regan³

2017

Folia Phoniatr Logop

View full text Add to dashboard Cite

Objective: Clinical guidelines place considerable emphasis on early swallow screening, as it has significant impact on patient outcomes. This study aims to examine perspectives and practices of speech and language therapists (SLTs) in the Republic of Ireland on swallow screening, exploring challenges in screening methods to improve practice and facilitate research. Methods: An 18-item web-based survey was devised targeting SLTs working in dysphagia in Republic of Ireland. Perspectives were sought on definitions of screening, models of practice, tests used, and factors influencing decision-making. Results: Fifty-eight SLTs responded, representing a cross section of clinical settings, populations, and experience. Screening tests most frequently employed were personal screening tests (80%). Important considerations reported in test selection were patient safety (100%), ease of use (97%), staffing (97.5%), and diagnostic accuracy (97.5%). Perceived challenges were staff training associated with screening. Conclusions: It is concerning that while diagnostic accuracy was recognised as important, most respondents used tests lacking in diagnostic accuracy. While the survey response rate was low, it is hypothesised that findings reflect practice. There is a need for SLTs to equip themselves with the skills to discern which screening test is most diagnostically accurate for clinical populations with further research to improve practice.

show abstract

“…25 Early screening for and managing dysphagia reduces pneumonia rates. 26,27 Up to 15% of patients will have persistent dysphagia requiring artificial nutrition, 28 and a gastrostomy tube may be the only option for nutritional support in these patients. It is unclear whether this intervention will contribute to similar improvement in patient-centered outcomes with established stroke prevention therapies.…”

mentioning

confidence: 99%

Quality improvement in neurology

et al. 2017

View full text Add to dashboard Cite

The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia

Abstract: . (2016). The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. Journal of Neurology, Neurosurgery and Psychiatry. https://doi

Cited by 155 publications

References 21 publications

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

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

Screening for Dysphagia: Perspectives and Practices of Speech and Language Therapists in the Republic of Ireland

Quality improvement in neurology

Contact Info

Product

Resources

About