Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke
Predictors and Outcomes of Dysphagia Screening After Acute Ischemic Stroke
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DOI：
10.1161/strokeaha.116.015332
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发表时间：
2017-04-01
期刊：
影响因子：
8.3
通讯作者：
Kapral, Moira K.
中科院分区：
文献类型：
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作者：
Joundi, Raed A.;Martino, Rosemary;Kapral, Moira K.
背景和目的-指南提倡对所有急性卒中患者进行吞咽困难筛查。然而，关于有多少和哪些患者接受筛查以及吞咽筛查失败如何影响患者结局的数据有限。方法-我们使用安大略卒中登记处从2010年4月1日至2013年3月31日，以确定急性缺血性卒中住院患者，并确定记录的吞咽困难筛查的预测因子和筛查试验失败后的结果，包括肺炎，残疾，结果-在7171例患者中，6677例患者有资格在72小时内接受吞咽困难筛查，但1280例（19.2%）患者未接受记录的筛查。轻度卒中患者进行记录筛选的可能性显著低于重度卒中患者（校正比值比，0.51; 95%置信区间[CI]，0.41-0.64）。吞咽困难筛查失败与不良结局相关，包括肺炎（校正比值比，4.71; 95% CI，3.43-6.47），重度残疾（校正比值比，5.19; 95% CI，4.48-6.02），出院至长期护理（校正比值比，2.79; 95%CI，2.11-3.79）和1年死亡率（校正风险比，2.42; 95%CI，2.09-2.80）。协会在轻度stroks. Conclusions患者中维持1/5的急性缺血性卒中患者没有记录的吞咽困难筛查，轻度卒中患者基本上不太可能有记录的筛查。吞咽困难筛查失败与不良结局相关，包括轻度卒中患者，强调了吞咽困难筛查对所有急性缺血性卒中患者的重要性。
Background and Purpose-Guidelines advocate screening all acute stroke patients for dysphagia. However, limited data are available regarding how many and which patients are screened and how failing a swallowing screen affects patient outcomes. We sought to evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test.Methods-We used the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to identify patients hospitalized with acute ischemic stroke and determine predictors of documented dysphagia screening and outcomes after failing the screening test, including pneumonia, disability, and death.Results-Among 7171 patients, 6677 patients were eligible to receive dysphagia screening within 72 hours, yet 1280 (19.2%) patients did not undergo documented screening. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio, 0.51; 95% confidence interval [CI], 0.41-0.64). Failing dysphagia screening was associated with poor outcomes, including pneumonia (adjusted odds ratio, 4.71; 95% CI, 3.43-6.47), severe disability (adjusted odds ratio, 5.19; 95% CI, 4.48-6.02), discharge to long-term care (adjusted odds ratio, 2.79; 95% CI, 2.11-3.79), and 1-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09-2.80). Associations were maintained in patients with mild strokes.Conclusions-One in 5 patients with acute ischemic stroke did not have documented dysphagia screening, and patients with mild strokes were substantially less likely to have documented screening. Failing dysphagia screening was associated with poor outcomes, including in patients with mild strokes, highlighting the importance of dysphagia screening for all patients with acute ischemic stroke.