Dysphagia screening method reduces post-stroke pneumonia
medwireNews: Early systematic screening for dysphagia, coupled with intensified oral hygiene practice can significantly reduce the rate of radiologic pneumonia among stroke patients, research shows.
In a prospective study, published in the Journal of Neuroscience Nursing, Danish researchers found that the strategy reduced the rate of confirmed pneumonia to a quarter of the rate observed when nonmethodical dysphagia screening and oral hygiene were employed.
The study included 58 acute stroke patients with moderate or severe dysphagia hospitalized between March 2009 and January 2010. They were screened using the Gugging Swallowing Screen immediately following admission and assigned to receive oral or tube feeding accordingly. They also received oral hygiene according to a detailed care plan including tooth brushing, protection and moistening of the oral cavity, and cleansing with chlorhexidine mouth rinse.
They were compared with an external control group of 30 patients treated at a neighboring hospital during the same time period and a historical internal control group of 58 patients treated at the unit between March 2008 and January 2009 before the strategy was introduced.
The difference in combined rates of X-ray verified and possible pneumonia between the intervention (34%) and control groups (both 43%) was nonsignificant, report authors Rikke Terp Sørensen (University Hospital of Copenhagen) and colleagues. However, the incidence of X-ray verified pneumonia was significantly higher in internal and external control groups at 28% and 27%, respectively, compared with 7% in the intervention group.
Additionally, they found that mortality was significantly reduced in the intervention group compared with the external control group at 12% and 30%, respectively at 30 days, and 33% and 57%, respectively at 180 days. However, the researchers note that patients in the external control group had greater stroke severity, which may have influenced this finding.
The authors also report that patients with suspected or confirmed pneumonia were more likely to be fed by nasogastric tube, have a lower Barthel Index score at 1 week and at discharge, and to have a history of chronic respiratory diseases. Unintended oral feeding in patients with severe dysphagia who were nil by mouth was also associated with an increased incidence of X-ray verified pneumonia.
The researchers say that further research is needed into factors associated with aspiration pneumonia, such as the use of nasogastric tubes.
"Process of care, such as mobilization, administration of nutrition, and oral hygiene, contributes in many ways to prevent aspiration pneumonia, and future research on the effectiveness of clinical interventions within the above topics is also necessary," they conclude.
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By Kirsty Oswald, medwireNews Reporter