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.
Keywords
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Article Info
Publication History
Published online: March 22, 2018
Accepted:
March 19,
2018
Received in revised form:
March 19,
2018
Received:
February 19,
2018
Footnotes
☆This research was not supported by a grant or external funding.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
