Overestimating the risk of aspiration in acute stroke

Trapl, Michaela; Teuschl, Yvonne; Matz, Karl; Dachenhausen, Alexandra; Brainin, Michael

doi:10.1111/ene.13298

Cited by 1 publication

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“…Furthermore, the data suggest that it may be safe to give medication orally, crushed and mixed with apple sauce to patients with severe dysphagia (8–9 points on the GUSS), as only 2/33 (6%) developed SAP compared to 30/212 (14%) of NPO patients. This allows parenteral nutrition in the first 2–3 days after the event in patients not being at risk for malnutrition—avoiding thereby nasogastric tubes [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Systematic dysphagia screening and dietary modifications to reduce stroke-associated pneumonia rates in a stroke-unit

et al. 2018

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Background and purposeWhile formal screening for dysphagia following acute stroke is strongly recommended, there is little evidence on how multi-consistency screening and dietary modifications affect the rate of stroke-associated pneumonia (SAP). This observational study reports which factors affect formal screening on a stroke-unit and how dietary recommendations relate to SAP.MethodAnalyses from a database including 1394 patients admitted with acute stroke at our stroke-unit in Austria between 2012 and 2014. Dietary modifications were performed following the recommendations from the Gugging Swallowing Screen (GUSS). Patients evaluated with GUSS were compared to the unscreened patients.ResultsOverall, 993 (71.2%) patients were screened with GUSS; of these 50 (5.0%) developed SAP. In the 401 unscreened patients, the SAP rate was similar: 22 (5.5%). Multivariable analysis showed that either mild to very mild strokes or very severe strokes were less likely to undergo formal screening. Older age, pre-existing disability, history of hypertension, atrial fibrillation, stroke severity, cardiological and neurological complications, nasogastric tubes, and intubation were significant markers for SAP. Out of 216 patients, 30 (13.9%) developed SAP in spite of receiving nil per mouth (NPO).ConclusionThe routine use of GUSS is less often applied in either mild strokes or very severe strokes. While most patients with high risk of SAP were identified by GUSS and assigned to NPO, dietary modifications could not prevent SAP in 1 of 7 cases. Other causes of SAP such as silent aspiration, bacteraemia or central breathing disturbances should be considered.

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Section: Discussionmentioning

confidence: 99%