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
Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases
Dysphagia Management and Outcomes in Elderly Stroke Patients with Malnutrition Risk: Results from Chinese Stroke Center Alliance
第一作者：Guitao Zhang
基本信息
- 负责人：Guitao Zhang
- 数据来源： OTHERS
- 论文编号：OTHERS20210096
- 发表时间：2022-03-17
2022-03-17
已发表文章
发表杂志：Clinical Interventions in Aging
发表类型: Original Contributions
影响因子(IF): 3.829
PMID: 35321149 Pubmed原文链接 全文下载
主要研究背景及目的
Dysphagia is common in stroke patients and increases risks of mortality and hospitalization complications. According to the nutrition screening 2002(NRS 2002), stroke patients older than 70 years were defined as being at malnutrition risk. Dysphagia and malnutrition influences with each other and is associated with adverse outcomes (i.e., pneumonia, all-cause mortality). Multiple guidelines recommend early dysphagia screening before oral food or tablets given in stroke patients. However, a systematic review showed that there was insufficient RCT data to determine whether dysphagia screening could reduce poor outcomes. Although guidelines strongly recommend dysphagia screening prior to oral food or drugs, evidences are still insufficient in clinical practice, especially in older ischemic stroke patients who are at malnutrition risk. We therefore test the effectiveness of dysphagia screening and subsequent swallowing rehabilitation in older ischemic stroke patients base on the Chinese Stroke Center Alliance (CSCA).
方法
Based on the Chinese Stroke Center Alliance (CSCA) from August 1, 2015 to July 21, 2019, we compared the in-hospital adverse outcomes among stroke patients (including ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage) over 70 years old with and without dysphagia screening. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were the composite endpoint of discharge against medical advice (DAMA) or in-hospital death.
结论
Dysphagia screening and swallowing rehabilitation were associated with a reduced risk of in-hospital death and composite outcome of DAMA or in-hospital death for stroke patients with malnutrition risk. Future research should concentrate on improving the quality of medical care for dysphagia management to improve patients’ outcomes.
主要结果
Among 365,530 stroke patients ≥ 70 years old with malnutrition risk in the CSCA, documented dysphagia screening was performed for 288,764 (79.0%) participants. Of these, 41,482 (14.37%) patients had dysphagia, and 33,548 (80.87%) patients received swallowing rehabilitation. A total of 1,694 (0.46%) patients experienced in-hospital death. After adjustment for traditional risk factors, dysphagia screening was associated with a low risk of all-cause mortality in stroke patients [adjusted odds ratio (aOR): 0.75, 95% confidence interval (CI):0.65–0.87]. Compared to patients with dysphagia who did not receive swallowing rehabilitation, patients reveiving swallowing rehabilitation had a reduced risk of in-hospital death (aOR:0.39, 95% CI: 0.33–0.46). Additionally, dysphagia screening had a lower risk for the composite endpoint of DAMA or in-hospital death (aOR:0.83,95% CI: 0.80–0.87), as did subsequent swallowing rehabilitation (aOR:0.43,95% CI: 0.40–0.47). Similar results were observed in the sensitivity analysis through inverse probability of treatment weighting, propensity score matching, and excluding patients without National Institutes of Health Stroke Scale scores. A similar association was observed between dysphagia management and adverse clinical outcomes in ischemic stroke and intracranial hemorrhage patients.