Published Online
on August 18, 2005

A more recent version of this article appeared on September 1, 2005

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Submitted on January 26, 2005
Accepted on February 8, 2005

Formal Dysphagia Screening Protocols Prevent Pneumonia

Judith A. Hinchey MD^*; Timothy Shephard RN, CN; Karen Furie MD, MPH; Don Smith MD; David Wang DO; Sarah Tonn MPH; for the Stroke Practice Improvement Network Investigators

From the Department of Neurology (J.A.H.), Saint Elizabeth’s Medical Center, Boston, Mass; Division of Clinical Care Research (J.A.H.), Tufts-New England Medical Center, Boston, Mass; Stroke Systems Consulting (T.S.), Charlottesville, Va; Massachusetts General Hospital (K.F.), Boston; Swedish Medical Center (D.S.), Englewood, Colo; OSF Stroke Center (D.W.), St. Francis Medical Center, Peoria, Ill; and IDaSTAT Consulting (S.T.), St. Paul, Minn.

^* To whom correspondence should be addressed. E-mail: Jhinchey{at}tufts-nemc.org.

Background--Pneumonia is an important complication of ischemic stroke and increases mortality 3-fold. Five guidelines recommend a dysphagia screen before oral intake. What constitutes an adequate dysphagia screen and which patients should receive it remain unclear.

Methods--Fifteen acute care institutions prospectively collected data on all admitted patients with acute ischemic stroke. Sites were required to collect data on demographics and 4 quality indicators. Optional data included stroke severity and complications. We measured adherence to a screen for dysphagia, the type of screen, and development of in-hospital pneumonia.

Results--Between December 2001 and January 2003, 2532 cases were collected. In-hospital complications were recorded on 2329 (92%) of cases. Stroke severity was captured on 1361 (54%). Adherence to a dysphagia screen was 61%. Six sites had a formal dysphagia screen, and their adherence rate was 78% compared with 57% at sites with no formal screen. The pneumonia rate at sites with a formal dysphagia screen was 2.4% versus 5.4% (P=0.0016) at sites with no formal screen. There was no difference in median stroke severity (5 versus 4; P=0.84) between the sites with and without a formal screen. A formal dysphagia screen prevented pneumonia even after adjusting for stroke severity.

Conclusions--A formal dysphagia screen is associated with a higher adherence rate to dysphagia screens and a significantly decreased risk of pneumonia. A formal screening protocol should be offered to all stroke patients, regardless of stroke severity.

Key words: complications • dysphagia • outcome assessment

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