Dysphagia screening underused, predicts stroke outcomes, study finds

Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening, but failing screening predicted adverse outcomes in patients with mild strokes.

Despite the potential benefits to predicting post-stroke outcomes, one in five patients with acute ischemic stroke did not receive dysphagia screening, and patients with mild strokes were substantially less likely to undergo screening, a study found.

To evaluate predictors of receiving dysphagia screening after acute ischemic stroke and outcomes after failing a screening test, researchers identified patients hospitalized with acute ischemic stroke via the Ontario Stroke Registry from April 1, 2010, to March 31, 2013, to determine predictors of screening and outcomes after failing the screening test, including pneumonia, disability, and death.

Results were published online on March 8 and will appear in the April Stroke.

Among 7,171 patients, 6,677 patients were eligible to receive dysphagia screening within 72 hours, yet 1,280 (19.2%) patients did not. Patients with mild strokes were significantly less likely than those with more severe strokes to have documented screening (adjusted odds ratio [OR], 0.51; 95% CI, 0.41 to 0.64). Failing dysphagia screening was associated with pneumonia (adjusted OR, 4.71; 95% CI, 3.43 to 6.47), severe disability (adjusted OR, 5.19; 95% CI, 4.48 to 6.02), discharge to long-term care (adjusted OR, 2.79; 95% CI, 2.11 to 3.79), and one-year mortality (adjusted hazard ratio, 2.42; 95% CI, 2.09 to 2.80).

Patients with a failed screening were also more likely to develop aspiration pneumonia (8.8% vs. 1.0%; adjusted OR, 6.5; 95% CI, 4.2 to 9.9) and decubitus ulcers (1.9% vs. 0.1%; adjusted OR, 12.7; 95% CI, 3.8 to 42.2) and were more likely to need a percutaneous feeding tube (9.0% vs. 0.1%; adjusted OR, 56.8; 95% CI, 20.9 to 154.4). Among patients with mild strokes, failing dysphagia screening also predicted pneumonia (8.2% vs. 1.3%; adjusted OR, 4.94; 95% CI, 3.14 to 7.89), severe disability (43.2% vs. 14.1%; adjusted OR, 4.01; 95% CI, 3.30 to 4.89), and placement of a percutaneous feeding tube (7.3% vs. <0.3%; adjusted OR, 88.9; 95% CI, 21.6 to 366).

The results highlight the importance of dysphagia screening for all patients with acute ischemic stroke, according the study authors. They wrote, “Failing a dysphagia screening test is a potent predictor of poor outcome, even among patients with mild strokes, who are at particular risk of not being screened. Clinicians and health administrators should be aware of the critical need for dysphagia screening after acute stroke, regardless of stroke severity.”