Stroke: failing a dysphagia screen tied to risks for pneumonia and poor clinical outcomes

  • Ouyang M & al.
  • Int J Stroke
  • 21 Jun 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Patients who failed dysphagia screen were at increased risk for pneumonia and poor clinical outcome after acute stroke.
  • Subsequent feeding restrictions were associated with increased risk of adverse outcomes.

Why this matters

  • Dysphagia is common and associated with aspiration pneumonia after stroke. However, limited data are available on the influences of dysphagia screen and assessment in clinical practice

Study design

  • Secondary analysis of multicentre, cluster cross-over, randomised controlled HeadPoST trial (11,093 adult patients with acute stroke) evaluating the association between dysphagia screening/assessment and clinical outcomes.
  • Funding: George Institute for Global Health and Clınica Alemana de Santiago.

Key results

  • 79.2% and 35.3% of patients were screened and assessed for dysphagia respectively; 3.3% of the patients developed pneumonia.
  • Patient who passed dysphagia screen vs who failed had significantly higher risk for pneumonia (1.5% vs 10.0%; adjusted OR [aOR], 3.00; 95% CI, 2.19-4.10).
  • At 90-day, significant association observed
    • in patients who failed dysphagia screen vs those who passed (68.1% vs 30.8%; aOR, 1.66; 95% CI, 1.41-2.95; P<.0001>
    • in patients who did not have a dysphagia assessment vs those who did, reported higher risk of poor outcome (47.5% vs 34.6%; P<.0001>
    • between dysphagia assessment and poor outcome in patients who passed a dysphagia screen (aOR, 1.39; 95% CI, 1.14-1.69),
    • between failing dysphagia assessment and increased risks for pneumonia (aOR, 3.04; 95% CI, 2.11-4.39) and poor outcome (aOR, 2.22; 95% CI, 1.76-2.80).
  • In patients who failed dysphagia screen or assessment, subsequent feeding restrictions were associated with a higher risk of pneumonia (aOR, 4.06; 95% CI, 1.72-9.54).

Limitation

  • Study did not prespecify screening and assessment methods.