Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study
Journal
International Journal of Stroke
ISSN
1747-4930
1747-4949
Date Issued
2020
Author(s)
Menglu Ouyang
Elizabeth Boaden
Hisatomi Arima
Pablo M Lavados
Laurent Billot
Maree L Hackett
Lili Song
Kris Rogers
Sandy Middleton
Octavio M Pontes-Neto
Tsong-Hai Lee
Caroline Watkins
Thompson Robinson
Craig S Anderson
Type
Resource Types::text::journal::journal article
URL Institutional Repository
Abstract
Dysphagia is associated with aspiration pneumonia after stroke. Data are limited on the influences of dysphagia screen and assessment in clinical practice. </jats:p></jats:sec><jats:sec><jats:title>Aims</jats:title><jats:p> To determine associations between a “brief” screen and “detailed” assessment of dysphagia on clinical outcomes in acute stroke patients. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A prospective cohort study analyzed retrospectively using data from a multicenter, cluster cross-over, randomized controlled trial (Head Positioning in Acute Stroke Trial [HeadPoST]) from 114 hospitals in nine countries. HeadPoST included 11,093 acute stroke patients randomized to lying-flat or sitting-up head positioning. Herein, we report predefined secondary analyses of the association of dysphagia screening and assessment and clinical outcomes of pneumonia and death or disability (modified Rankin scale 3–6) at 90 days. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Overall, 8784 (79.2%) and 3917 (35.3%) patients were screened and assessed for dysphagia, respectively, but the frequency and timing for each varied widely across regions. Neither use of a screen nor an assessment for dysphagia was associated with the outcomes, but their results were compared to “screen-pass” patients, those who failed had higher risks of pneumonia (adjusted odds ratio [aOR] = 3.00, 95% confidence interval [CI] = 2.18–4.10) and death or disability (aOR = 1.66, 95% CI = 1.41–1.95). Similar results were evidence for the results of an assessment for dysphagia. Subsequent feeding restrictions were related to higher risk of pneumonia in patients failed dysphagia screen or assessment (aOR = 4.06, 95% CI = 1.72–9.54). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Failing a dysphagia screen is associated with increased risks of pneumonia and poor clinical outcome after acute stroke. Further studies concentrate on determining the effective subsequent feeding actions are needed to improve patient outcomes.
Cite this document
Ouyang, M., Boaden, E., Arima, H., Lavados, P. M., Billot, L., Hackett, M. L., Olavarría, V. V., Muñoz-Venturelli, P., Song, L., Rogers, K., Middleton, S., Pontes-Neto, O. M., Lee, T.-H., Watkins, C., Robinson, T., Anderson, C. S., & for the HeadPoST Investigators. (2020). Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study. International Journal of Stroke, 15(2), 206-215. https://doi.org/10.1177/1747493019858778
Subjects
dysphagia
;
screen
;
assessment
;
acute stroke
;
pneumonia
;
disability
;
clinical trial
;
aged
;
aged, 80 and over
;
cross-over studies
;
deglutition disorders
;
disability evaluation
;
female
;
humans
;
male
;
mass screening
;
middle aged
;
pneumonia
;
prospective studies
;
risk factors
;
stroke
;
adverse outcome
;
aged
;
article
;
cerebrovascular accident
;
clinical outcome
;
cohort analysis
;
comparative study
;
death
;
disability study
;
disease assessment
;
disease association
;
dysphagia
;
feeding behavior
;
female
;
high risk patient
;
human
;
major clinical study
;
male
;
multicenter study (topic)
;
pneumonia
;
priority journal
;
prospective study
;
rankin scale
;
retrospective study
;
risk factor
;
screening
;
sitting
;
stroke patient
;
cerebrovascular accident
;
clinical trial
;
complication
;
controlled study
;
crossover procedure
;
disability
;
dysphagia
;
mass screening
;
middle aged
;
multicenter study
;
pneumonia
;
randomized controlled trial
;
risk factor
;
very elderly