Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study
Author
dc.contributor.author
Ouyang, Menglu
Author
dc.contributor.author
Boaden, Elizabeth
Author
dc.contributor.author
Arima, Hisatomi
Author
dc.contributor.author
Lavados Germain, Pablo Manuel
Author
dc.contributor.author
Billot, Laurent
Author
dc.contributor.author
Hackett, Maree L.
Author
dc.contributor.author
Olavarría, Verónica V.
Author
dc.contributor.author
Muñoz Venturelli, Paula
Author
dc.contributor.author
Song, Lili
Author
dc.contributor.author
Rogers, Kris
Author
dc.contributor.author
Middleton, Sandy
Author
dc.contributor.author
Pontes Neto, Octavio M.
Author
dc.contributor.author
Lee, Tsong Hai
Author
dc.contributor.author
Watkins, Caroline
Author
dc.contributor.author
Robinson, Thompson
Author
dc.contributor.author
Anderson, Craig S.
Admission date
dc.date.accessioned
2019-10-30T15:29:58Z
Available date
dc.date.available
2019-10-30T15:29:58Z
Publication date
dc.date.issued
2019
Cita de ítem
dc.identifier.citation
International Journal of Stroke · June 2019
Identifier
dc.identifier.issn
17474949
Identifier
dc.identifier.issn
17474930
Identifier
dc.identifier.other
10.1177/1747493019858778
Identifier
dc.identifier.uri
https://repositorio.uchile.cl/handle/2250/172446
Abstract
dc.description.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.