The Relationship Between Dysphagia and Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis

Chang, Min Cheol; Choo, Yoo Jin; Seo, Kyung Cheon; Yang, Seoyon

doi:10.3389/fneur.2022.834240

Cited by 30 publications

(14 citation statements)

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“…Swallowing dysfunction can propitiate the introduction of oral content including food or fluids such as saliva in the respiratory tract, potentially leading to aspiration pneumonia 12,13 . The correlation between dysphagia and aspiration pneumonia has previously been proven in longitudinal studies 14 and a recent systematic review found dysphagia to be a risk factor for pneumonia in patients attended for stroke 15 . The higher risk of aspiration pneumonia in patients with dysphagia is also associated with increased hospital stay and mortality risk 5 …”

Section: Introductionmentioning

confidence: 99%

“…12,13 The correlation between dysphagia and aspiration pneumonia has previously been proven in longitudinal studies 14 and a recent systematic review found dysphagia to be a risk factor for pneumonia in patients attended for stroke. 15 The higher risk of aspiration pneumonia in patients with dysphagia is also associated with increased hospital stay and mortality risk. 5 In the context of the quality and patient safety improvement initiatives in our tertiary hospital in Barcelona, concerns about the incidence of aspiration pneumonia among in-patients triggered the will to quantify the prevalence of dysphagia and its correlation with pneumonia.…”

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confidence: 99%

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Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality

Bosch

Comas

Domingo

et al. 2022

Eur J Clin Investigation

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Background Oropharyngeal dysphagia can be highly concerning in hospitalized patients, increasing morbidity and mortality, making its early identification essential. We aimed to characterize dysphagia and its association with aspiration pneumonia and mortality in a tertiary hospital in Barcelona, Spain. Methods Using data from all hospital discharges during the period 2018–2021, we identified the characteristics of patients with dysphagia and their distribution among hospital departments through the minimum data set, which codifies patients' diagnoses according to the International Classification of Diseases 10th Revision (ICD‐10). We used logistic regression models to assess the association between dysphagia, aspiration pneumonia and mortality. Results Dysphagia was present in 2.4% of all hospital discharges and was more frequent in older patients and in men. The diagnoses most frequently associated with dysphagia were aspiration pneumonia (48.2%) and stroke (14%). Higher prevalence of dysphagia was found in the acute geriatric unit (10.3%), neurology (7.6%) and internal medicine (7.5%) wards. Dysphagia was associated with aspiration pneumonia, aOR = 8.04 (95%CI, 6.31–10.25), and independently increased the odds of death among hospitalized patients, aOR = 1.43 (95%CI, 1.19–1.73). Conclusions We conclude that dysphagia is a prevalent and transversal condition, increasing the risk of mortality in all patients, and efforts should be intensified to increase its early detection and correct management.

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Section: Introductionmentioning

confidence: 99%

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confidence: 99%

Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality

Bosch

Comas

Domingo

et al. 2022

Eur J Clin Investigation

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“…The stage of dysphagia may be related to stroke and tracheostomy. Chang et al reported that in patients with acute cerebral infarction, dysphagia usually occurs in the oral and pharyngeal stages [ 38 ]. Betts et al reported that the tube cuff could obstruct the pharyngeal pathway directly [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Exploring the Influence of Dysphagia and Tracheostomy on Pneumonia in Patients with Stroke: A Retrospective Cohort Study

Dai

Qiao

et al. 2022

Brain Sciences

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Background: Pneumonia is common in patients with tracheostomy and dysphagia. However, the influence of dysphagia and tracheostomy on pneumonia in patients with stroke remains unclear. The aim of this study was to explore the risk factors related to pneumonia, and the association between dysphagia, tracheostomy and pneumonia in patients with stroke was investigated. Methods: Patients with stroke who experienced tracheostomy and dysphagia were included and divided into two groups based on record of pneumonia at discharge. Clinical manifestations and physical examination were used to diagnose pneumonia, whereas clinical swallowing examination, and videofluoroscopy swallowing studies (VFSS) were used to evaluate swallowing function. Results: There were significant differences between the pneumonia group and the no pneumonia group in total tracheostomy time (6.3 ± 5.9 vs. 4.3 ± 1.7 months, p = 0.003), number of instances of ventilator support (0.41 ± 0.49 vs. 0.18 ± 0.38, p = 0.007), PAS score (5.2 ± 1.92 vs. 4.3 ± 1.79, p = 0.039), impaired or absent cough reflex (76.4 vs. 55.6%, p = 0.035), oropharyngeal phase dysfunction (60.6 vs. 40.8%, p = 0.047), length of hospital stay (36.0 ± 7.2 vs. 30.5 ± 11.7 days, p = 0.025) and direct medical costs (15,702.21 ± 14,244.61 vs. 10,923.99 ± 7250.14 United States dollar [USD], p = 0.042). Multivariate logistic regression showed that the total tracheostomy time (95% confidence interval [CI], 1.966–12.922, p = 0.001), impaired or absent cough reflex (95% CI, 0.084–0.695, p = 0.008), and oropharyngeal phase dysfunction (95% CI, 1.087–8.148, p = 0.034) were risk factors for pneumonia. Spearman’s correlation analysis demonstrated that PAS scores were significantly correlated with cough reflex dysfunction (r = 0.277, p = 0.03), oropharyngeal phase dysfunction (r = 0.318, p < 0.01) and total tracheostomy time (r = 0.178, p = 0.045). The oropharyngeal phase dysfunction was significantly correlated with cough reflex (r = 0.549, p < 0.001) and UES opening (r = 0.643, p < 0.01). Conclusions: Tracheostomy and dysphagia increased the risk of pneumonia in patients with stroke. Total tracheostomy time, duration of ventilator support, degree of penetration and aspiration, and oropharyngeal phase dysfunction are risk factors. Given this, we also found that there may be a correlation between tracheostomy and dysphagia.

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“…Cluster : Clinically relevant studies of post-stroke pneumonia Clinical symptoms of dysphagia could contribute to the development of post-stroke pneumonia (57). Data show that up to 50% of patients with post-stroke presented clinically with dysphagia, and nearly half of them were at risk of aspiration (58).…”

Section: Research Hotpots Of Global Publicationsmentioning

confidence: 99%

Bibliometric analysis of global research trends on post-stroke pneumonia: Current development status and research Frontiers

Chen

2022

Front. Public Health

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BackgroundAs one of the most common complications of stroke, post-stroke pneumonia significantly increases the incidence of adverse outcomes, mortality, and healthcare costs for patients with stroke. As the field of post-stroke pneumonia has gained interest in the recent years, there has been an increasing number of publications on post-stroke pneumonia research worldwide. Therefore, a more comprehensive understanding of the field is needed now. This paper is intended to analyze the research status and detect the research frontiers in this field.MethodsVOS viewer, CiteSpace, and the online scientometric platform (https://bibliometric.com/) were the main visualization tools used in this paper. They were used to perform citation analysis of countries/institutions, co-citation analysis of authors/journals/references, co-authorship analysis of authors, co-occurrence analysis of keywords, and citation bursts analysis of references.ResultsThe number of publications in this field has increased rapidly since 2010 and is expected to continue to increase in the next few years. The countries contributing most to post-stroke pneumonia research were the USA, China, and Germany. The most productive institution was Harvard University, followed by Humboldt University of Berlin, Charité Universitätsmedizin Berlin, and Free University of Berlin from Germany. Meanwhile, the German authors Meisel A, Meisel C, and Dirnagl U, who have contributed significantly to this field, were all associated with these three German institutions. The high-quality and high output journal was STROKE. In the coming years, the hot topic keywords “risk & risk-factors,” “outcome & impact,” “management & guidelines,” and “predictors” will gain more attention in this field. Finally, hot keywords were grouped into four clusters in this paper: cluster 1 (risk-factors studies of post-stroke pneumonia), cluster 2 (clinically relevant studies of post-stroke pneumonia), cluster 3 (mechanism studies of post-stroke pneumonia), and cluster 4 (care studies of post-stroke pneumonia).ConclusionThis study shows the knowledge structure and evolution of the field of post-stroke pneumonia research and predicts research trends through visualization analysis. The future trend of post-stroke pneumonia research will gradually shift from clinical and mechanistic studies to treatment and prevention studies.

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The Relationship Between Dysphagia and Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis

Cited by 30 publications

References 35 publications

Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality

Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality

Exploring the Influence of Dysphagia and Tracheostomy on Pneumonia in Patients with Stroke: A Retrospective Cohort Study

Bibliometric analysis of global research trends on post-stroke pneumonia: Current development status and research Frontiers

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