• Shihab Masrur, Eric E Smith, Jeffrey L Saver, Mathew J Reeves, Deepak L Bhatt, Xin Zhao, DaiWai Olson, Wenqin Pan, Adrian F Hernandez, Gregg C Fonarow, and Lee H Schwamm.
• Department of Medicine, Berkshire Medical Center, Pittsfield, Massachusetts. Electronic address: shihabmasrur@hotmail.com.
• J Stroke Cerebrovasc Dis. 2013 Nov 1; 22 (8): e301-9.

BackgroundNational guidelines recommend dysphagia screening (DS) before oral intake in stroke patients to reduce hospital-acquired pneumonia (HAP). We examined the relationship between DS and HAP after ischemic stroke.MethodsGet with the Guidelines-Stroke defines HAP as postadmission diagnosis of pneumonia requiring antibiotics, and DS as the use of bedside swallow screening prior to oral intake. Univariable and multivariable analyses examined the relationship between DS and HAP.ResultsAmong 314,007 ischemic stroke patients at 1244 Get with the Guidelines-Stroke hospitals from 2003-2009 who were eligible for DS and had completed HAP data, a total of 216,372 (68.9%) underwent DS and a total of 17,906 (5.7%) developed HAP. When compared with patients without HAP, patients with HAP were older, had admission National Institutes of Health Stroke Scale (NIHSS) score (median NIHSS score: 10 versus 4), were more likely to undergo DS (75.5% versus 68.5%), and had increased length of stay and in-hospital mortality (12.4% versus 2.3%). In multivariable analyses, factors independently associated with a lower risk of HAP were female gender (odds ratio [OR] 0.84), dyslipidemia (OR 0.84), and hypertension (OR 0.94). DS was associated with a higher adjusted OR for HAP (OR 1.40), but the OR was greatly attenuated after adding NIHSS score to the model (OR 1.10).ConclusionsHAP occurs in 1 of 17 hospitalized stroke patients and is associated with a greater than 5-fold increase in mortality. DS did not occur in 31.1% of eligible patients, with increased screening among those with more severe strokes and those who developed HAP. The attenuation of the relationship between DS and HAP risk when controlling for NIHSS score suggests the association between screening and pneumonia is confounded by severity. Controlled trials are needed to determine DS effectiveness.Copyright © 2013 National Stroke Association. Published by Elsevier Inc. All rights reserved.

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