Utility of Dysphagia Screening Results in Predicting Poststroke Pneumonia

Abstract

Background and Purpose-Dysphagia screening before oral intake (DS) is a stroke care quality indicator. The value of DS is unproven. Quality adherence and outcome data from the Paul Coverdell National Acute Stroke Registry were examined to establish value of DS. Methods-Adherence to the DS quality indicator was examined in patients with stroke discharged from Paul Coverdell National Acute Stroke Registry hospitals between March 1 and December 31, 2009. Patients were classified as unscreened (US), screened and passed (S/P), and screened and failed. Associations between screening status and pneumonia rate were assessed by logistic regression models after adjustment for selected variables. Results-A total of 18 017 patients with stroke discharged from 222 hospitals in 6 states were included. A total of 4509 (25%) were US; 8406 (47%) were S/P, and 5099 (28%) were screened and failed. Compared with US patients, screened patients were significantly more impaired. Pneumonia rates were: US 4.2%, S/P 2.0%, and screened and failed 6.8%. After adjustment for demographic and clinical features, US patients were at a higher risk of pneumonia (OR, 2.2; 95% CI, 1.7 to 2.7) compared with S/P patients. Conclusions-Data suggest that patients are selectively screened based on stroke severity. Pneumonia rate was higher in US patients compared with S/P patients. Clinical judgment regarding who should be screened is imperfect. S/P patients have a lower pneumonia rate indicating that DS adds accuracy in predicting pneumonia risk. The Joint Commission recently retired DS as a performance indicator for Primary Stroke Center certification. These results suggest the need to implement a DS performance measure for patients with acute stroke. (Stroke. 2010;41:2849-2854.)

Guidelines for Adult Stroke Rehabilitation and Recovery

“…389 Additionally, observational studies suggest that dysphagia screening reduces the risk of pneumonia. 390 A systematic review of 8 studies demonstrated that the odds of being malnourished were increased if dysphagia was present after stroke. 391 Despite the potential consequences of dysphagia, a review of nursing nutritional care concluded that a functional, supportive, and educational nursing nutritional role was essential, but little evidence was of sufficient quality to support policy and practice development or to inform education.…”

Development of a Clinical Score (A 2 DS 2 ) to Predict Pneumonia in Acute Ischemic Stroke

“…Variables associated with poststroke pneumonia at a significance level of 0.1 in univariate analysis were included in a multivariable logistic regression model using a backward elimination procedure. Due to prior reports that male sex is a significant predictor for poststroke pneumonia, 16 we a priori decided to include sex in the list of our possible predictors. We defined an OR in multivariable analyses of Ն1.25 to be clinically meaningful for prediction of poststroke pneumonia.…”

Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit

“…Studies in different patient populations indicate that up to half of the patients admitted to hospital with acute stroke may be undernourished and that probably as many initially present with dysphagia. [1][2][3][4][5][6][7] Undernutrition develops as a consequence of insufficient protein and energy intake over time, leading to altered body composition and impaired biological function. In patients with acute stroke, undernutrition is an independent risk factor for poorer functional outcomes that is potentially modifiable.…”