Dysphagia and factors associated with respiratory infections in the first week post stroke.
BACKGROUND
Dysphagia occurs in approximately half of the stroke patients and is associated with respiratory infections; however, it is unclear what other factors contribute to an increased risk. This study aimed to provide evidence on factors associated with respiratory infections in the very acute stroke period.


METHODS
Retrospective review of 536 stroke patients admitted to Australian Hospitals in 2010. Data were collected on 37 clinical and demographic parameters. Univariable and multivariable logistic regression was performed.


RESULTS
The overall incidence of respiratory infection was 11%. On admission, requiring full assistance with mobility [OR 6.48, 95% CI 1.35, 31.16] and urinary incontinence [OR 3.21, 95% CI 1.16, 8.87] were associated with respiratory infections. During the first week post stroke nasogastric tubes (NGT) [OR 3.91, 95% CI 1.73, 8.80] and Nil By Mouth (NBM) [OR 5.62, 95% CI 1.54, 20.46] were associated with respiratory infections. Impaired GCS, ischaemic stroke and significantly impaired mobility were associated with swallowing difficulties.


CONCLUSIONS
This study of a large cohort of acute stroke patients supports research indicating aspiration pneumonia is multifactorial in nature. NGT were associated with increased risk of respiratory infections and may contribute to infections by promoting oropharyngeal colonisation. Patients with severely impaired mobility were also at very high risk of respiratory infection.
Sir Charles Gairdner Hospital, Nedlans, Western Australia, Australia.
Emily
E
Brogan
Claire
C
Langdon
Kim
K
Brookes
Charley
C
Budgeon
David
D
Blacker
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000150:complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000150:complications / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000150:complications* / Q000453:epidemiology*; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications*