Raed A Joundi1, Rosemary Martino1, Gustavo Saposnik1, Vasily Giannakeas1, Jiming Fang1, Moira K Kapral2. 1. From the Division of Neurology, Department of Medicine (R.A.J.), Department of Speech-Language Pathology, Graduate Department of Rehabilitation Science (R.M.), Institute of Health Policy, Management and Evaluation (G.S., M.K.K.), and Department of Medicine, Division of General Internal Medicine (M.K.K.), University of Toronto, Ontario, Canada; Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St Michael's Hospital (G.S.); Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada (R.M.); Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada (V.G., J.F., M.K.K.); and Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada (M.K.K.). 2. From the Division of Neurology, Department of Medicine (R.A.J.), Department of Speech-Language Pathology, Graduate Department of Rehabilitation Science (R.M.), Institute of Health Policy, Management and Evaluation (G.S., M.K.K.), and Department of Medicine, Division of General Internal Medicine (M.K.K.), University of Toronto, Ontario, Canada; Stroke Outcomes Research Unit, Division of Neurology, Department of Medicine, St Michael's Hospital (G.S.); Health Care and Outcomes Research, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada (R.M.); Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada (V.G., J.F., M.K.K.); and Division of General Internal Medicine and Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada (M.K.K.). Moira.Kapral@uhn.ca.
Abstract
BACKGROUND AND PURPOSE: Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test. METHODS: We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death. RESULTS: Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes. CONCLUSIONS: One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke.
BACKGROUND AND PURPOSE: Guidelines advocate screening all acute strokepatients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test. METHODS: We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death. RESULTS: Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes. CONCLUSIONS: One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke.
Authors: Aaron Berkowitz; Nirali Vora; Morgan L Prust; Deanna Saylor; Stanley Zimba; Fred Stephen Sarfo; Gentle S Shrestha Journal: Stroke Date: 2022-01-20 Impact factor: 7.914