Utility of dysphagia screening results in predicting poststroke pneumonia.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA. laksh004@umn.edu
Kamakshi
K
Lakshminarayan
Albert W
AW
Tsai
Xin
X
Tong
Gabriela
G
Vazquez
James M
JM
Peacock
Mary G
MG
George
Russell V
RV
Luepker
David C
DC
Anderson
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000150:complications; D002543:Cerebral Hemorrhage / Q000150:complications; D003244:Consciousness Disorders; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology*; D011785:Quality Assurance, Health Care; D012042:Registries; D018570:Risk Assessment; D012737:Sex Factors; D020521:Stroke / Q000150:complications* / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000150:complications; D016896:Treatment Outcome; D055815:Young Adult