Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study.

Ouyang, M; Boaden, E; Arima, H; Lavados, PM; Billot, L; Hackett, ML; Olavarría, VV; Muñoz-Venturelli, P; Song, L; Rogers, K; Middleton, S; Pontes-Neto, OM; Lee, T-H; Watkins, C; Robinson, T; Anderson, CS; HeadPoST Investigators

Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study.

Ouyang, M Boaden, E Arima, H Lavados, PM Billot, L Hackett, ML Olavarría, VV Muñoz-Venturelli, P Song, L Rogers, K

Middleton, S Pontes-Neto, OM Lee, T-H Watkins, C Robinson, T Anderson, CS HeadPoST Investigators

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Publisher:: SAGE Publications
Publication Type:: Journal Article
Citation:: International Journal of Stroke, 2020, 15, (2), pp. 206-215
Issue Date:: 2020-02

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Field	Value	Language
dc.contributor.author	Ouyang, M
dc.contributor.author	Boaden, E
dc.contributor.author	Arima, H
dc.contributor.author	Lavados, PM
dc.contributor.author	Billot, L
dc.contributor.author	Hackett, ML
dc.contributor.author	Olavarría, VV
dc.contributor.author	Muñoz-Venturelli, P
dc.contributor.author	Song, L
dc.contributor.author	Rogers, K https://orcid.org/0000-0001-5497-4298
dc.contributor.author	Middleton, S
dc.contributor.author	Pontes-Neto, OM
dc.contributor.author	Lee, T-H
dc.contributor.author	Watkins, C
dc.contributor.author	Robinson, T
dc.contributor.author	Anderson, CS
dc.contributor.author	HeadPoST Investigators
dc.date.accessioned	2020-08-12T06:37:46Z
dc.date.available	2020-08-12T06:37:46Z
dc.date.issued	2020-02
dc.identifier.citation	International Journal of Stroke, 2020, 15, (2), pp. 206-215
dc.identifier.issn	1747-4930
dc.identifier.issn	1747-4949
dc.identifier.uri	http://hdl.handle.net/10453/142070
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.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	SAGE Publications
dc.relation.ispartof	International Journal of Stroke
dc.relation.isbasedon	10.1177/1747493019858778
dc.rights	info:eu-repo/semantics/restrictedAccess
dc.subject	1103 Clinical Sciences, 1109 Neurosciences
dc.subject.classification	Neurology & Neurosurgery
dc.title	Dysphagia screening and risks of pneumonia and adverse outcomes after acute stroke: An international multicenter study.
dc.type	Journal Article
utslib.citation.volume	15
utslib.location.activity	United States
utslib.for	1103 Clinical Sciences
utslib.for	1109 Neurosciences
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney
utslib.copyright.status	closed_access	*
pubs.consider-herdc	true
dc.date.updated	2020-08-12T06:37:42Z
pubs.issue	2
pubs.publication-status	Published
pubs.volume	15
utslib.citation.issue	2

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.

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http://hdl.handle.net/10453/142070