Menglu Ouyang1,2, Elizabeth Boaden3, Hisatomi Arima1,4, Pablo M Lavados5,6,7, Laurent Billot1, Maree L Hackett1,3, Verónica V Olavarría5,6, Paula Muñoz-Venturelli1,5,6, Lili Song1,2, Kris Rogers1, Sandy Middleton8, Octavio M Pontes-Neto9, Tsong-Hai Lee10, Caroline Watkins3, Thompson Robinson11, Craig S Anderson1,2,12. 1. The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, Australia. 2. The George Institute China at Peking University Health Science Center, Beijing, China. 3. Faculty of Health and Wellbeing, University of Central Lancashire, Preston, Lancashire, UK. 4. Department of Preventive Medicine and Public Health, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 5. Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Santiago, Chile. 6. Facultad de Medicina, Clinica Alemana Universidad del Desarrollo, Santiago, Chile. 7. Departamento de Ciencias Neurológicas, Facultad de Medicina, Universidad de Chile Universidad de Chile, Santiago, Chile. 8. Nursing Research Institute, St Vincent's Health (Sydney) Australia, Australian Catholic University, Sydney, Australia. 9. Stroke Service-Neurology Division, Department of Neuroscience and Behavioral Sciences, Ribeirão Preto Medical School, University of Sao Paulo, Sao Paulo, Brazil. 10. Stroke Center and Department of Neurology, Linkou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan. 11. Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK. 12. Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia.
Abstract
BACKGROUND:Dysphagia is associated with aspiration pneumonia after stroke. Data are limited on the influences of dysphagia screen and assessment in clinical practice. AIMS: To determine associations between a "brief" screen and "detailed" assessment of dysphagia on clinical outcomes in acute stroke patients. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
RCT Entities:
BACKGROUND:Dysphagia is associated with aspiration pneumonia after stroke. Data are limited on the influences of dysphagia screen and assessment in clinical practice. AIMS: To determine associations between a "brief" screen and "detailed" assessment of dysphagia on clinical outcomes in acute strokepatients. METHODS: 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 strokepatients 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Barbara Schumacher Finnegan; Melissa M Meighan; Noelani C Warren; Meghan K Hatfield; Stacey Alexeeff; Jorge Lipiz; Mai Nguyen-Huynh Journal: Perm J Date: 2020-12