Are Differences in Dysphagia Assessment, Oral Care Provision, or Nasogastric Tube Insertion Associated with Stroke-Associated Pneumonia? A Nationwide Survey Linked to National Stroke Registry Data

Sabrina A Eltringham; Benjamin D Bray; Craig J Smith; Sue Pownall; Karen Sage

doi:10.1159/000519903

Are Differences in Dysphagia Assessment, Oral Care Provision, or Nasogastric Tube Insertion Associated with Stroke-Associated Pneumonia? A Nationwide Survey Linked to National Stroke Registry Data

Cerebrovasc Dis. 2022;51(3):365-372. doi: 10.1159/000519903. Epub 2021 Dec 16.

Authors

Sabrina A Eltringham^{1

2}, Benjamin D Bray³, Craig J Smith^{4

5}, Sue Pownall¹, Karen Sage²

Affiliations

¹ Speech and Language Therapy Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
² Faculty of Health and Education, Manchester Metropolitan University, Manchester, UK.
³ School of Population Health and Environmental Sciences, King's College London, London, UK.
⁴ Manchester Centre for Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.
⁵ Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK.

PMID: 34915473
DOI: 10.1159/000519903

Abstract

Introduction: Stroke-associated pneumonia (SAP) is a common complication associated with poor outcomes. Early dysphagia screening and specialist assessment is associated with a reduced risk of SAP. Evidence about oral care and nasogastric tube (NGT) placement is equivocal. This study aimed to expose variations in dysphagia management practices and explore their associations with SAP.

Participants and methods: Speech pathologists from 166 stroke units in England and Wales were surveyed about dysphagia assessment and management, oral care, and NGT placement. Survey data were then linked to the Sentinel Stroke National Audit Programme (SSNAP), the national register of stroke. Univariable and multivariable linear regression models were fitted to estimate the association between dysphagia management practices and SAP incidence.

Results: 113 hospitals completed the survey (68%). Variation was evident in dysphagia screening protocols (DSPs), oral care, and NGT practice while specialist swallow assessment data patterns were more consistent. Multivariable analysis showed no evidence of an association in incidence of SAP when using a water-only hospital DSP compared to a multiconsistency DSP (B -0.688, 95% CI: -2.912 to 1.536), when using written swallow assessment guidelines compared to not using written guidelines (B 0.671, 95% CI: -1.567 to 2.908), when teams inserted NGTs overnight compared to teams which did not (B -0.505, 95% CI: -2.759 to 1.749), and when teams had a written oral care protocol compared to those which did not (B -1.339, 95% CI: -3.551 to 0.873).

Discussion and conclusion: Variation exists in dysphagia screening and management, but there was no evidence of an association between clinical practice patterns and incidence of SAP. Further research with larger sample sizes is needed to examine association with SAP.

Keywords: Acute stroke; Dysphagia assessment; Nasogastric tube feeding; Oral care; Stroke-associated pneumonia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Deglutition Disorders* / diagnosis
Deglutition Disorders* / epidemiology
Deglutition Disorders* / therapy
Humans
Pneumonia* / diagnosis
Pneumonia* / epidemiology
Pneumonia* / therapy
Registries
Stroke Rehabilitation* / methods
Stroke* / complications
Stroke* / diagnosis
Stroke* / epidemiology