The Multidisciplinary Swallowing Team Approach Decreases Pneumonia Onset in Acute Stroke Patients

Abstract

Dysphagia occurs in acute stroke patients at high rates, and many of them develop aspiration pneumonia. Team approaches with the cooperation of various professionals have the power to improve the quality of medical care, utilizing the specialized knowledge and skills of each professional. In our hospital, a multidisciplinary participatory swallowing team was organized. The aim of this study was to clarify the influence of a team approach on dysphagia by comparing the rates of pneumonia in acute stroke patients prior to and post team organization. All consecutive acute stroke patients who were admitted to our hospital between April 2009 and March 2014 were registered. We analyzed the difference in the rate of pneumonia onset between the periods before team organization (prior period) and after team organization (post period). Univariate and multivariate analyses were performed using a Cox proportional hazards model to determine the predictors of pneumonia. We recruited 132 acute stroke patients from the prior period and 173 patients from the post period. Pneumonia onset was less frequent in the post period compared with the prior period (6.9% vs. 15.9%, respectively; p = 0.01). Based on a multivariate analysis using a Cox proportional hazards model, it was determined that a swallowing team approach was related to pneumonia onset independent from the National Institutes of Health Stroke Scale score on admission (adjusted hazard ratio 0.41, 95% confidence interval 0.19–0.84, p = 0.02). The multidisciplinary participatory swallowing team effectively decreased the pneumonia onset in acute stroke patients.

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

“…Kalra et al [31] and Kalra et al [32] used the same RCT data. Study designs included RCTs (30%) [15,[31][32][33], prospective (20%) [13,34] and retrospective (40%) [35][36][37][38] observational studies and one quasi-experimental design [39]. Europe hosted 55% of studies [15,[31][32][33][34]37], Australia 27% [13,36,38] and Japan 18% [35,39].…”

“…Other possible sources of bias and quality considerations in the RCT and non-RCT studies include small population size and risk of measurement bias. There was a lack of objective measurement of the MDT swallowing approach [39] and the potential bias of progressive proficiency of implementing the MDT protocol over time [37]. Other examples of measurement bias included lack of information about the diagnosis and method of assessment of dysphagia and subsequent measurement and severity rating, and classification of stroke severity.…”

“…Measurement of pneumonia timing varied. Four studies reported pneumonia during hospitalization [33,34,37,39]. Three studies reported within 14 days of admission [31,32,35] and one from 7 days of admission [36].…”

Negotiating The Maze: Confronting Dysphagia Together With My Stroke-Afflicted Family Member

“…A multidisciplinary team may consist of neurologists, nurses, rehabilitation physicians, speech therapists, physical therapists, nutritionists, radiologists, and pharmacists (Aoki et al, 2016;Gandolfi et al, 2014). The family caregivers in the present study were unsatisfied with the lack of adequate information regarding dysphagia care, especially from physicians and nurses.…”

“…A multidisciplinary team approach offers an effective model for the management of post-stroke dysphagia (Aoki et al, 2016;Gandolfi et al, 2014). A multidisciplinary team may consist of neurologists, nurses, rehabilitation physicians, speech therapists, physical therapists, nutritionists, radiologists, and pharmacists (Aoki et al, 2016;Gandolfi et al, 2014).…”