Sabrina A Eltringham1,2, Karen Kilner3, Melanie Gee3, Karen Sage3, Benjamin D Bray4, Sue Pownall5,3, Craig J Smith6,7. 1. Department of Speech and Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdomsabrina.eltringham@sth.nhs.uk. 2. Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdomsabrina.eltringham@sth.nhs.uk. 3. Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom. 4. Sentinel Stroke National Audit Programme, Royal College of Physicians, London, United Kingdom. 5. Department of Speech and Language Therapy, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom. 6. Greater Manchester Comprehensive Stroke Centre, Manchester Academic Health Science Centre, Salford Royal Foundation Trust, Salford, United Kingdom. 7. Division of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom.
Abstract
BACKGROUND: Patients with dysphagia are at an increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed during the acute phase. The aim of this review was to identify the methods of assessment and management in acute stroke that influence the risk of stroke-associated pneumonia. Studies of stroke patients that reported dysphagia screening, assessment or management and occurrence of pneumonia during acute phase stroke were screened for inclusion after electronic searches of multiple databases from inception to November 2016. The primary outcome was association with stroke-associated pneumonia. SUMMARY: Twelve studies of 87,824 patients were included. The type of dysphagia screening protocol varied widely across and within studies. There was limited information on what comprised a specialist swallow assessment and alternative feeding was the only management strategy, which was reported for association with stroke-associated pneumonia. Use of a formal screening protocol and early dysphagia screening (EDS) and assessment by a speech and language pathologist (SLP) were associated with a reduced risk of stroke-associated pneumonia. There was marked heterogeneity between the included studies, which precluded meta-analysis. Key Messages: There is variation in the assessment and management of dysphagia in acute stroke. There is increasing evidence that EDS and specialist swallow assessment by an SLP may reduce the odds of stroke-associated pneumonia. There is the potential for other factors to influence the incidence of stroke-associated pneumonia during the acute phase.
BACKGROUND:Patients with dysphagia are at an increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed during the acute phase. The aim of this review was to identify the methods of assessment and management in acute stroke that influence the risk of stroke-associated pneumonia. Studies of strokepatients that reported dysphagia screening, assessment or management and occurrence of pneumonia during acute phase stroke were screened for inclusion after electronic searches of multiple databases from inception to November 2016. The primary outcome was association with stroke-associated pneumonia. SUMMARY: Twelve studies of 87,824 patients were included. The type of dysphagia screening protocol varied widely across and within studies. There was limited information on what comprised a specialist swallow assessment and alternative feeding was the only management strategy, which was reported for association with stroke-associated pneumonia. Use of a formal screening protocol and early dysphagia screening (EDS) and assessment by a speech and language pathologist (SLP) were associated with a reduced risk of stroke-associated pneumonia. There was marked heterogeneity between the included studies, which precluded meta-analysis. Key Messages: There is variation in the assessment and management of dysphagia in acute stroke. There is increasing evidence that EDS and specialist swallow assessment by an SLP may reduce the odds of stroke-associated pneumonia. There is the potential for other factors to influence the incidence of stroke-associated pneumonia during the acute phase.
Authors: T B Jannini; M Ruggiero; A Viganò; A Comanducci; I Maestrini; G Giuliani; E Vicenzini; F Fattapposta; F Pauri; G Ruoppolo; M Toscano; V Di Piero Journal: Neurol Sci Date: 2021-07-16 Impact factor: 3.307