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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

Research output: Contribution to journalArticlepeer-review

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

Original languageEnglish
JournalCEREBROVASCULAR DISEASES
DOIs
Accepted/In press2021

Bibliographical note

Funding Information: We would like to thank the participants, Sentinel Stroke National Audit Programme (SSNAP), for their contribution as data providers, as well as the people and organizations participating in SSNAP. The research team acknowledges the support of the National Institute for Health Research Clinical Research Network (NIHR CRN). Funding Information: This work was supported by the Stroke Association (Grant No. SE-TSA PGF 2017/03). Publisher Copyright: © 2021 The Author(s). Published by S. Karger AG, Basel.

King's Authors

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.

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