Early Dysphagia Screening by Trained Nurses Reduces Pneumonia Rate in Stroke Patients: A Clinical Intervention Study

Stroke. 2017 Sep;48(9):2583-2585. doi: 10.1161/STROKEAHA.117.018157. Epub 2017 Jul 17.

Abstract

Background and purpose: Dysphagia is a common stroke symptom and leads to serious complications such as aspiration and pneumonia. Early dysphagia screening can reduce these complications. In many hospitals, dysphagia screening is performed by speech-language therapists who are often not available on weekends/holidays, which results in delayed dysphagia assessment.

Methods: We trained the nurses of our neurological department to perform formal dysphagia screening in every acute stroke patient by using the Gugging Swallowing Screen. The impact of a 24/7 dysphagia screening (intervention) over swallowing assessment by speech-language therapists during regular working hours only was compared in two 5-month periods with time to dysphagia screening, pneumonia rate, and length of hospitalization as outcome variables.

Results: Overall, 384 patients (mean age, 72.3±13.7 years; median National Institutes of Health Stroke Scale score of 3) were included in the study. Both groups (pre-intervention, n=198 versus post-intervention, n=186) were comparable regarding age, sex, and stroke severity. Time to dysphagia screening was significantly reduced in the intervention group (median, 7 hours; range, 1-69 hours) compared with the control group (median, 20 hours; range, 1-183; P=0.001). Patients in the intervention group had a lower rate of pneumonia (3.8% versus 11.6%; P=0.004) and also a reduced length of hospital stay (median, 8 days; range, 2-40 versus median, 9 days; range, 1-61 days; P=0.033).

Conclusions: 24/7 dysphagia screening can be effectively performed by nurses and leads to reduced pneumonia rates. Therefore, empowering nurses to do a formal bedside screening for swallowing dysfunction in stroke patients timely after admission is warranted whenever speech-language therapists are not available.

Keywords: deglutition disorders; nursing; pneumonia; stroke.

Publication types

  • Clinical Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Deglutition Disorders / diagnosis*
  • Female
  • Humans
  • Length of Stay
  • Male
  • Mass Screening
  • Middle Aged
  • Nursing Assessment
  • Pneumonia / epidemiology
  • Pneumonia, Aspiration / epidemiology*
  • Severity of Illness Index
  • Stroke / epidemiology
  • Stroke / nursing*
  • Time Factors