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

Journal：BMJ Open

Publication type: Article

IF(IF): 2.9

PMID: 38238044 Link To Pubmed Full text Download

Background: Post-stroke dysphagia is prevalent in hospitalized patients and dysphagia following stroke represents a substantial health issue，affecting between 37% to 78% of stroke survivors.Dysphagia after stroke can lead to significant complications such as malnutrition,respiratory infections and subsequent pneumonia which lead to poor prognosis and high mortality rates when compared with stroke without dysphagia. Intracerebral hemorrhage is a common form of stroke; it accounts for one fifth of all cases.Intracerebral hemorrhage dysphagia remains a neglected area of research despite guidelines advocating dysphagia screening of all patients with acute stroke.In three studies, roughly one-quarter to one-third of patients with ICH do not receive documented screening for dysphagia. Rates of dysphagia screen failure also differ among studies, from 43% to 77% in unselected ICH.there is limited data are available regarding how many and which patients are screened , how they compare to ischemic stroke and how failing a swallowing screen affects patient outcomes. Purpose: We used data from the China Stroke Center Alliance to examine the frequency and determinants of an assessment for swallowing function among ICH patients.To compare outcomes between those who passed and failed dysphagia screen result, 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).