title: Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit.
abstract: Dysphagia increases the risk of pneumonia in stroke patients. This study aimed to evaluate bedside swallowing screening for prevention of stroke-associated pneumonia (SAP) in acute stroke patients admitted to the intensive care unit (ICU). Consecutive acute stroke patients admitted to the stroke ICU from May 2006 to March 2007 were included. Patients were excluded if they were intubated on the first day of admission or had a transient ischemic attack. A 3-Step Swallowing Screen was introduced since October 2006 and therefore patients were divided into pre-screen and post-screen groups. A binary logistic regression model was used to determine independent risk factors for SAP and in-hospital death. There were 74 and 102 patients included in the pre- and post-screen groups, respectively. Pneumonia was associated with higher National Institutes of Health Stroke Scale (NIHSS) score, older age, nasogastric and endotracheal tube placement. After adjusting for age, gender, NIHSS score and nasogastric and endotracheal tube insertion, dysphagia screening was associated with a borderline decrease in SAP in all stroke patients (odds ratio, 0.42; 95% CI, 0.18-1.00; p=0.05). However, dysphagia screening was not associated with reduction of in-hospital deaths. Systematic bedside swallowing screening is helpful for prevention of SAP in acute stroke patients admitted to the ICU.
authors.affiliation: Department of Neurology, Yun-Lin Branch of National Taiwan University Hospital, No. 579, Sec. 2, Yunlin Rd., Douliu City, Yunlin County, Taiwan.
authors.forename: Shin-Joe
authors.initials: SJ
authors.lastname: Yeh
authors.forename: Kuang-Yu
authors.initials: KY
authors.lastname: Huang
authors.forename: Tyng-Guey
authors.initials: TG
authors.lastname: Wang
authors.forename: Yee-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Chung-Hwa
authors.initials: CH
authors.lastname: Chen
authors.forename: Sung-Chun
authors.initials: SC
authors.lastname: Tang
authors.forename: Li-Kai
authors.initials: LK
authors.lastname: Tsai
authors.forename: Ping-Keung
authors.initials: PK
authors.lastname: Yip
authors.forename: Jiann-Shing
authors.initials: JS
authors.lastname: Jeng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000150:complications* / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000209:etiology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D020521:Stroke / Q000150:complications*; D013624:Taiwan