Advertisement

The use of an emergency department dysphagia screen is associated with decreased pneumonia in acute strokes

Published:March 22, 2018DOI:https://doi.org/10.1016/j.ajem.2018.03.046

      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

      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Smithard D.G.
        • Smeeton N.C.
        • Wolfe C.D.A.
        Long-term outcome after stroke: does dysphagia matter?.
        Age Ageing. 2007; 36: 90-94
        • Altman K.W.
        • Yu G.
        • Schaefer S.D.
        Consequence of dysphagia in the hospitalized patient: impact on prognosis and hospital resources.
        Arch Otolaryngol Head Neck Surg. 2010; 136: 784-789
        • Paciaroni M.
        • Mazzotta G.
        • Corea F.
        • Caso V.
        • Venti M.
        • Milia P.
        • et al.
        Dysphagia following stroke.
        Eur Neurol. 2004; 51: 162-167
        • Martino R.
        • Foley N.
        • Bhogal S.
        • Diamant N.
        • Speechley M.
        • Teasell R.
        Dysphagia after stroke, incidence, diagnosis, and pulmonary complications.
        Stroke. 2005; 36: 2756-2763
        • Adams H.P.
        • del Zoppo G.
        • Alberts M.J.
        • Bhatt D.L.
        • Brass L.
        • Furlan A.
        • et al.
        Guidelines for the early management of adults with ischemic stroke, a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists.
        Circulation. 2007; 115: e478-e534
        • Yeh S.-J.
        • Huang K.-Y.
        • Wang T.-G.
        • Chen Y.-C.
        • Chen C.-H.
        • Tang S.-C.
        • et al.
        Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit.
        J Neurol Sci. 2011; 306: 38-41
        • Titsworth W.L.
        • Abram J.
        • Fullerton A.
        • Hester J.
        • Guin P.
        • Waters M.F.
        • et al.
        Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke.
        Stroke. 2013; 44: 3154-3160
        • Powers W.J.
        • Rabinstein A.A.
        • Ackerson T.
        • Adeoye O.M.
        • Bambakidis N.C.
        • Becker K.
        • et al.
        Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2018; https://doi.org/10.1161/str.0000000000000158(2018
        • Daniels S.K.
        • Anderson J.A.
        • Petersen N.J.
        Implementation of stroke dysphagia screening in the emergency department.
        Nurs Res Pract. 2013; 2013: 304190
        • Turner-Lawrence D.E.
        • Peebles M.
        • Price M.F.
        • Singh S.J.
        • Asimos A.W.
        A feasibility study of the sensitivity of emergency physician dysphagia screening in acute stroke patients.
        Ann Emerg Med. 2009; 54 (348 e341): 344-348
        • Schrock J.W.
        • Bernstein J.
        • Glasenapp M.
        • Drogell K.
        • Hanna J.
        A novel emergency department dysphagia screen for patients presenting with acute stroke.
        Acad Emerg Med. 2011; 18: 584-589
        • Lakshminarayan K.
        • Tsai A.W.
        • Tong X.
        • Vazquez G.
        • Peacock J.M.
        • George M.G.
        • et al.
        Utility of dysphagia screening results in predicting poststroke pneumonia.
        Stroke. 2010; 41: 2849-2854
        • Guyomard V.
        • Fulcher R.A.
        • Redmayne O.
        • Metcalf A.K.
        • Potter J.F.
        • Myint P.K.
        Effect of dysphasia and dysphagia on inpatient mortality and hospital length of stay: a database study.
        J Am Geriatr Soc. 2009; 57: 2101-2106
        • Martino R.
        • Pron G.
        • Diamant N.
        Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines.
        Dysphagia. 2000; 15: 19-30
        • Smith E.E.
        • Kent D.M.
        • Bulsara K.R.
        • Leung L.Y.
        • Lichtman J.H.
        • Reeves M.J.
        • Towfighi A.
        • Whiteley W.N.
        • Zahuranec D.B.
        • C. American Heart Association Stroke
        Effect of dysphagia screening strategies on clinical outcomes after stroke: a systematic review for the 2018 guidelines for the early management of patients with acute ischemic stroke.
        Stroke. 2018; https://doi.org/10.1161/STR.0000000000000159