Utility of Dysphagia Screening Results in Predicting Poststroke Pneumonia

Dysphagia screening before oral intake (DS) is a stroke care quality indicator. The value of DS is unproven. Quality adherence and outcome data from the Paul Coverdell National Acute Stroke Registry were examined to establish value of DS. Adherence to the DS quality indicator was examined in patient...

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Bibliographic Details
Published in:Stroke (1970) 2010-12, Vol.41 (12), p.2849-2854
Main Authors: LAKSHMINARAYAN, Kamakshi, TSAI, Albert W, XIN TONG, VAZQUEZ, Gabriela, PEACOCK, James M, GEORGE, Mary G, LUEPKER, Russell V, ANDERSON, David C
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Biological and medical sciences
Brain Ischemia - complications
Cerebral Hemorrhage - complications
Consciousness Disorders
Deglutition Disorders - diagnosis
Deglutition Disorders - etiology
Ethnic Groups
Female
Humans
Length of Stay
Logistic Models
Male
Medical sciences
Middle Aged
Neurology
Neuropharmacology
Pharmacology. Drug treatments
Pneumonia - diagnosis
Pneumonia - etiology
Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer
Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease)
Psychology. Psychoanalysis. Psychiatry
Psychopharmacology
Quality Assurance, Health Care
Registries
Risk Assessment
Sex Factors
Stroke - complications
Stroke - etiology
Subarachnoid Hemorrhage - complications
Treatment Outcome
Vascular diseases and vascular malformations of the nervous system
Young Adult
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Summary:Dysphagia screening before oral intake (DS) is a stroke care quality indicator. The value of DS is unproven. Quality adherence and outcome data from the Paul Coverdell National Acute Stroke Registry were examined to establish value of DS. Adherence to the DS quality indicator was examined in patients with stroke discharged from Paul Coverdell National Acute Stroke Registry hospitals between March 1 and December 31, 2009. Patients were classified as unscreened (US), screened and passed (S/P), and screened and failed. Associations between screening status and pneumonia rate were assessed by logistic regression models after adjustment for selected variables. A total of 18 017 patients with stroke discharged from 222 hospitals in 6 states were included. A total of 4509 (25%) were US; 8406 (47%) were S/P, and 5099 (28%) were screened and failed. Compared with US patients, screened patients were significantly more impaired. Pneumonia rates were: US 4.2%, S/P 2.0%, and screened and failed 6.8%. After adjustment for demographic and clinical features, US patients were at a higher risk of pneumonia (OR, 2.2; 95% CI, 1.7 to 2.7) compared with S/P patients. Data suggest that patients are selectively screened based on stroke severity. Pneumonia rate was higher in US patients compared with S/P patients. Clinical judgment regarding who should be screened is imperfect. S/P patients have a lower pneumonia rate indicating that DS adds accuracy in predicting pneumonia risk. The Joint Commission recently retired DS as a performance indicator for Primary Stroke Center certification. These results suggest the need to implement a DS performance measure for patients with acute stroke.
ISSN:0039-2499
1524-4628
1524-4628
DOI:10.1161/strokeaha.110.597039