Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

Journal：stroke & vascular neurology

Publication type: Clinical Study

IF(IF): 9.893

PMID: 35260437 Link To Pubmed Full text Download

Backgroude: Dysphagia is a common problem, occurs in 37%–78% acute stroke patients[1, 2] and can lead to serious complications such as aspiration and pneumonia, which can increase rates of death and disability[3-6]. Moreover, swallowing dysfunction has been associated with prolonged hospital stays, higher admittance rates to nursing homes, and increased healthcare costs[7]. The accuracy and reliability of dysphagia assessment is critical to identifying patients at risk and designing an effectiveness care plan. Methods for the assessment of aspiration risk include videofluoroscopy, fiberoptic endoscopic evaluation, and comprehensive speech pathology evaluation [8]. However, these assessments require access to technology or specialty expertise with limited availability. Dysphagia screening using a brief bedside screening tool, such as a water swallow test, is not enough to against gold standard assessment of aspiration risk, but it is easy to perform in clinical practice. Typically, all appropriate patients are screened for dysphagia, and those in whom dysphagia is suspected go on to receive a comprehensive assessment. Guidelines for the early management of patients with acute ischemic stroke (AIS) recommended dysphagia screening before the patient begins eating, drinking, or receiving oral medications to identify patients who are at low risk of aspiration and who can then be safely given food, liquids, and medications [9]. However, there is little data on current practice in China on the dysphagia screening for AIS patients after admission, and there were insufficient data to determine whether implementation of a dysphagia screening protocol reduces the risk of pneumonia, death or dependency. Purpose: Using the data from the CSCA[10], our objective was to assess the degree and determinants of implementation of dysphagia screening, and to compare outcomes between those who passed and failed dysphagia screening, including multiple in-hospital complications and mortality.

The implementation and analysis of the study is based on CSCA. The CSCA is a national, hospital-based, multicentre, voluntary, multifaceted intervention and continuous QI initiative. Patients were recruited consecutively in all 1476 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 acute ischemic stroke confirmed by brain CT or MRI; (3) are within 7 days of symptom onset; (4) are admitted either directly to wards or through the emergency department. Patients with TIA 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, disability, 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.