Jon W Schrock1, Linda Lou2, Benjamin A W Ball3, J Van Etten4. 1. MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, United States. Electronic address: jschrock@metrohealth.org. 2. 280 E. Broad St., Rochester, NY 14604, United States. Electronic address: Lw14@case.edu. 3. 32 Winchester St Apt 2, Brookline, MA 02446, United States. Electronic address: bab@case.edu. 4. 3231 W 82nd St., Cleveland, OH 44102, United States. Electronic address: jkv@case.edu.
Abstract
BACKGROUND: Dysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute stroke patients. METHODS: We conducted a pre-post trial evaluating rates of pneumonia in patients with ischemic and hemorrhagic stroke both before and after the use of our ED dysphagia screen. We defined HAP as a new infiltrate treated with antibiotics. Rates of HAP were compared using the χ2 test. Any patients transferred out of our health system were excluded. RESULTS: We evaluated 419 and 469 preintervention hemorrhagic strokes and 1022 and 462 post screen ischemic strokes respectively. In the hemorrhagic groups rates of dysphagia were similar but rates of HAP decreased from 19% to 15% (P < 0.001) in the pre- post groups respectively. In the ischemic stroke groups rates of HAP decreased from 13.8% to 8% in the pre-post groups respectively, (P = 0.007). Rates of intubation were similar in the hemorrhagic groups and were higher in the post screen ischemic stroke cohort. CONCLUSION: The use of our ED dysphagia screen was associated with a significant reduction in the rates of HAP in both ischemic and hemorrhagic stroke patients. Given the high rates of dysphagia and significant comorbidity and complications for these stroke patients, the use of a screen is warranted.
BACKGROUND:Dysphagia is a common problem for patients after an acute stroke which can lead to hospital acquired pneumonia (HAP) increasing morbidity and mortality. The Joint Commission has directed that stroke certified hospitals perform a dysphagia screen at the time of initial presentation. We sought to evaluate if our ED dysphagia screen was correlated with lower rates of pneumonia in acute strokepatients. METHODS: We conducted a pre-post trial evaluating rates of pneumonia in patients with ischemic and hemorrhagic stroke both before and after the use of our ED dysphagia screen. We defined HAP as a new infiltrate treated with antibiotics. Rates of HAP were compared using the χ2 test. Any patients transferred out of our health system were excluded. RESULTS: We evaluated 419 and 469 preintervention hemorrhagic strokes and 1022 and 462 post screen ischemic strokes respectively. In the hemorrhagic groups rates of dysphagia were similar but rates of HAP decreased from 19% to 15% (P < 0.001) in the pre- post groups respectively. In the ischemic stroke groups rates of HAP decreased from 13.8% to 8% in the pre-post groups respectively, (P = 0.007). Rates of intubation were similar in the hemorrhagic groups and were higher in the post screen ischemic stroke cohort. CONCLUSION: The use of our ED dysphagia screen was associated with a significant reduction in the rates of HAP in both ischemic and hemorrhagic strokepatients. Given the high rates of dysphagia and significant comorbidity and complications for these strokepatients, the use of a screen is warranted.