Dysphagia Screening and Clinical Outcomes After Stroke

Eric E. Smith, David Kent, Ketan Bulsara, Lester Leung, Judith H. Lichtman, Mathew Reeves, Amytis Towfighi, William Whiteley, Darin B. Zahuranec

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction—Dysphagia screening protocols have been recommended to identify patients at risk for aspiration. The American Heart Association convened an evidence review committee to systematically review evidence for the effectiveness of dysphagia screening protocols to reduce the risk of pneumonia, death, or dependency after stroke.
Methods—The Medline, Embase, and Cochrane databases were searched on November 1, 2016, to identify randomized controlled trials (RCTs) comparing dysphagia screening protocols or quality interventions with increased dysphagia screening rates and reporting outcomes of pneumonia, death, or dependency.
Results—Three RCTs were identified. One RCT found that a combined nursing quality improvement intervention targeting fever and glucose management and dysphagia screening reduced death and dependency but without reducing the pneumonia rate. Another RCT failed to find evidence that pneumonia rates were reduced by adding the cough reflex to routine dysphagia screening. A smaller RCT randomly assigned 2 hospital wards to a stroke care pathway including dysphagia screening or regular care and found that patients on the stroke care pathway were less likely to require intubation and mechanical ventilation; however, the study was small and at risk for bias.
Conclusions—There were insufficient RCT data to determine the effect of dysphagia screening protocols on reducing the rates of pneumonia, death, or dependency after stroke. Additional trials are needed to compare the validity, feasibility, and clinical effectiveness of different screening methods for dysphagia.
Original languageEnglish
JournalStroke
Early online date24 Jan 2018
DOIs
Publication statusE-pub ahead of print - 24 Jan 2018

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