国家神经系统疾病临床医学研究中心数据管理与共享系统

发表杂志：CNS Neuroscience & Therapeutics

发表类型: Article

影响因子(IF): 7.035

PMID: 35233938 Pubmed原文链接 全文下载

Dysphagia or impaired swallowing is common after stroke, affecting between 37% to 78% of stroke survivors.Dysphagia is associated with increased risk of death or dependency, occurrence of pneumonia, poor quality of life, and longer hospital stay.Proper assessment of swallowing problems is one of the most important topics in stroke care. Screening protocols have been developed to identify patients at risk of dysphagia,and earlier screening has been shown to prevent pneumonia. Subarachnoid hemorrhage (SAH) is a serious and complex disease, the 30-day mortality rate is 18%~40%.Despite guidelines advocating dysphagia screening of all patients with acute stroke, little is known about dysphagia screening practices after SAH , and how the compare to ischemic stroke.In Previous studies, only one-third of patients with SAH were screened, rates of dysphagia screen failure is roughly 41%. Patients with SAH who fail dysphagia screening have a higher odds of developing pneumonia.However, there is a lack of data regarding the effect of dysphagia on other inhospital outcomes, discharge disability, and mortality in patients with SAH. We used data from the China Stroke Center Alliance to examine the frequency and determinants of an assessment for swallowing function among SAH patients. and to compare outcomes between those who passed and failed dysphagia screening, including multiple in-hospital complications and discharge disability.

The CSCA was designed from the CSA under the guidance of the National Center of Neurological Diseases Care Management. The CSCA is a national, hospital-based,multicentre,voluntary, multifaceted intervention and continuous QI initiative.Patients were recruited consecutively in all1476 hospitals from August 2015 to July 2017, who met the following criteria:(1) are aged 18 years or older; (2) have a primary diagnosis of  intracerebral haemorrhage ;(3) are within 7 days of symptom onset; (4) are admitted either directly to wards or through the emergency department . Patients with cerebral venous sinus thrombosis or non-cerebrovascular diseases were excluded. The proportion of patients who received dysphagia screening was described at the patient level. Baseline patient-level characteristics were compared for patients with and without a dysphagia screening and hospital-level features were compared for hospitals above and below the median rate of assessment by using Pearson chi-square tests for categorical variables and Mann-Whitney U test for continuous variables. A multivariable logistic regression model with the generalized estimating equation method accounting for in-hospital clustering was performed to identify patient and hospital characteristics independently associated with dysphagia screening. A multiple logistic regression was used to estimate the effect of failinging dysphagia screening on the odds of pneumonia, in-hospital mortality, length of stay, and total ，hospitalization cost. All tests are two-tailed with p < 0.05 to be considered as the level of statistical significance. All analyses were performed by using SAS Version 9.3 software (SAS Institute, Cary, NC, USA).