• I R Odderson, J C Keaton, and B S McKenna.
• Overlake Hospital Medical Center, Seattle, USA.
• Arch Phys Med Rehabil. 1995 Dec 1; 76 (12): 1130-3.

ObjectiveTo assess the effects of swallowing management in patients with acute nonhemorrhagic stroke placed on a clinical pathway, and to evaluate whether swallow function on admission can be used as a predictor of length of stay (LOS) and outcome disposition.DesignIntervention study to reduce complications of dysphagia in patients with acute stroke.SettingUrban community hospital.PatientsData were collected on 124 patients with acute nonhemorrhagic stroke admitted from January to December 1993.InterventionsA swallow screen was completed within one day of admission and before any oral intake.Main Outcome MeasuresDysphagia and functional independence measure (FIM) scores on admission, occurrence of aspiration pneumonia, LOS, outcome disposition and cost effectiveness analysis.ResultsThirty-nine percent of all patients (p < .05) failed the initial swallow screen and required altered dietary texture and intervention. No patients developed aspiration pneumonia. Of those with dysphagia, 21% recovered intact swallowing by discharge; 19% required gastrostomy tube placement. Patients with dysphagia had lower admission FIM scores than nondysphagia patients. The LOS was longer for the dysphagia group (8.4 +/- 0.9 days) compared with patients without dysphagia (6.4 +/- 0.6 days, p < .05). Patients with dysphagia were less likely to be discharged to home (27%) than were nondysphagia patients (55%), and twice as likely to be discharged to a nursing home (p < .05).ConclusionsThis study demonstrates that early swallow screening and dysphagia management in patients with acute stroke reduces the risk of aspiration pneumonia, is cost effective, and assures quality care with optimal outcome.

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