Utility of Dysphagia Screening Results in Predicting Poststroke Pneumonia
Kamakshi LakshminarayanAlbert W. TsaiXin TongGabriela VázquezJames M. PeacockMary G. GeorgeRussell V. LuepkerDavid C. Anderson
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Background and Purpose— Dysphagia screening before oral intake (DS) is a stroke care quality indicator. The value of DS is unproven. Quality adherence and outcome data from the Paul Coverdell National Acute Stroke Registry were examined to establish value of DS. Methods— Adherence to the DS quality indicator was examined in patients with stroke discharged from Paul Coverdell National Acute Stroke Registry hospitals between March 1 and December 31, 2009. Patients were classified as unscreened (US), screened and passed (S/P), and screened and failed. Associations between screening status and pneumonia rate were assessed by logistic regression models after adjustment for selected variables. Results— A total of 18 017 patients with stroke discharged from 222 hospitals in 6 states were included. A total of 4509 (25%) were US; 8406 (47%) were S/P, and 5099 (28%) were screened and failed. Compared with US patients, screened patients were significantly more impaired. Pneumonia rates were: US 4.2%, S/P 2.0%, and screened and failed 6.8%. After adjustment for demographic and clinical features, US patients were at a higher risk of pneumonia (OR, 2.2; 95% CI, 1.7 to 2.7) compared with S/P patients. Conclusions— Data suggest that patients are selectively screened based on stroke severity. Pneumonia rate was higher in US patients compared with S/P patients. Clinical judgment regarding who should be screened is imperfect. S/P patients have a lower pneumonia rate indicating that DS adds accuracy in predicting pneumonia risk. The Joint Commission recently retired DS as a performance indicator for Primary Stroke Center certification. These results suggest the need to implement a DS performance measure for patients with acute stroke.Keywords:
Stroke
Background
Dysphagia is a frequent finding in patients with HD. Up to 75% of the patients die of aspiration pneumonia. Symptoms of dysphagia already start in the very beginning of HD and become more severe when the disease progresses. The different symptoms of dysphagia in HD are already known. It is also known that there are treatment possibilities for dysphagia, such as the Masako and the Mendelsohn manoeuvre, but these are validated for other diseases, like a cerebro vascular accident or Parkinson's disease. There is no evidence that patients with HD benefit from this treatment. In our experience with HD, patients do benefit from dysphagia treatment. In this presentation dysphagia symptoms are presented using X-ray imaging, further, some treatment possibilities for dysphagia will be introduced by presenting a case study.Method
X-ray images on dysphagia symptoms during the different stages of HD were collected. More than 30 HD patients with dysphagia were treated using the Masako and Mendelsohn manoeuvre. For one specific patient a video was made to make a report of her swallowing progress.Results
X-ray images of dysphagia in HD were collected and will be shown in the presentation. More than 30 HD patients were treated for dysphagia using the Masako and Mendelsohn manoeuvre. Most patients could perform at least one manoeuvre, and most patients reported that they benefit from the treatment. For one specific patient a video was made to document the swallowing progress. The video was published on www.huntingtonplein.nl.Conclusion
An impressive collection of X-ray imaging on dysphagia in HD exists. For treatment possibilities, patients with HD seem to benefit from especially the Masako and Mendelsohn manoeuvre. For one patient the findings were documented and recorded on a video. This video was published on www.huntingtonplein.nl, and parts of this video will be presented during the presentation.Aspiration Pneumonia
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Abstract Dysphagia is commonly defined as difficulty swallowing. Although the disorder can have several causes, the patient's medication is often overlooked as a source of the problem. This type of dysphagia, one of the most readily corrected, is known as drug-induced dysphagia. A thorough literature search was undertaken to determine the potential for drug-induced dysphagia. Drug-induced dysphagia can be classified into one of three categories: dysphagia as a side effect, dysphagia as a complication of therapeutic action, and medication-induced esophageal injury. Examples of medications in each category are provided based on therapeutic classification. Specifically, the role of dysphagia in multiple sclerosis and the agents that have been linked with dysphagia are discussed. The most valuable method of preventing drug-induced dysphagia is obtaining a thorough and accurate medication history from each patient. Other prevention strategies and compensatory techniques are also explored.
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[Objective]To discussion the incidences of dysphagia after stroke at different age stages and in different parts of lesions,as well as corresponding measures.[Methods]The proportions of dysphagia of 620 cases of stroke patients in different age stages and parts of lesions were compared.[Results]The 60-90 age group(77%),the basal ganglia(48%)and brainstem lesion(23%)had higher proportion of dysphagia,which were significantly different with other age stages and other parts of lesions(P﹤0.05).[Conclusions]Elderly patients after stroke are more prone to be with dysphagia than young patients,Basal ganglia and brainstem lesions more easily cause dysphagia than other parts of lesions.
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Thyrotoxicosis refers to the clinical manifestations associated with elevated serum levels of T4 or T3 in an individual. Dysphagia is a common problem but a rare manifestation of hyperthyroidism. Dysphagia is an uncommon manifestation of thyrotoxic myopathy. Reports have been sparse and its incidence is not clear. In our case report patient presented who with dysphagia and weight loss and investigation revealed hyperthyroidism. Patient dysphagia subsequently resolved after receiving treatment with methimazole and beta-blockers. This case report the need to include thyrotoxicosis in the differential diagnosis of an otherwise unexplained case of dysphagia.
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ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Dylczyk-Sommer A. Dysphagia. Part 2: Dysphagia in intensive care patients. Anaesthesiology Intensive Therapy. 2020;52(3):233-236. doi:10.5114/ait.2020.98490. APA Dylczyk-Sommer, A. (2020). Dysphagia. Part 2: Dysphagia in intensive care patients. Anaesthesiology Intensive Therapy, 52(3), 233-236. https://doi.org/10.5114/ait.2020.98490 Chicago Dylczyk-Sommer, Anna. 2020. "Dysphagia. Part 2: Dysphagia in intensive care patients". Anaesthesiology Intensive Therapy 52 (3): 233-236. doi:10.5114/ait.2020.98490. Harvard Dylczyk-Sommer, A. (2020). Dysphagia. Part 2: Dysphagia in intensive care patients. Anaesthesiology Intensive Therapy, 52(3), pp.233-236. https://doi.org/10.5114/ait.2020.98490 MLA Dylczyk-Sommer, Anna. "Dysphagia. Part 2: Dysphagia in intensive care patients." Anaesthesiology Intensive Therapy, vol. 52, no. 3, 2020, pp. 233-236. doi:10.5114/ait.2020.98490. Vancouver Dylczyk-Sommer A. Dysphagia. Part 2: Dysphagia in intensive care patients. Anaesthesiology Intensive Therapy. 2020;52(3):233-236. doi:10.5114/ait.2020.98490.
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Objective:Todetermineifcomorbiddysphagiainallhospitalizedpatientshasthepotentialtoprolonghospitalstay and increase morbidity. Dysphagia is increasingly prevalent with age and comorbid medical conditions. Our researchgrouphaspreviouslyshownthatdysphagiaisabad prognostic indicator in patients with stroke. Design: Analysis of national database. Main Outcome Measures: The National Hospital Discharge Survey (NHDS), 2005-2006, was evaluated for presence of dysphagia and the most common comorbid medicalconditions.Patientdemographics,associateddisease,lengthofhospitalstay,morbidityandmortalitywere also evaluated. Results: There were over 77 million estimated hospital admissionsintheperiodevaluated,ofwhich271983were associated with dysphagia. Dysphagia was most commonlyassociatedwithfluidorelectrolytedisorder,esophagealdisease,stroke,aspirationpneumonia,urinarytract infection,andcongestiveheartfailure.Themediannumber of hospitalization days for all patients with dysphagia was 4.04 compared with 2.40 days for those patients without dysphagia. Mortality increased substantially in patients with dysphagia associated with rehabilitation, intervertebral disk disorders, and heart diseases. Conclusions:Dysphagiahasasignificantimpactonhospitallengthofstayandisabadprognosticindicator.Early recognition of dysphagia and intervention in the hospitalized patient is advised to reduce morbidity and length of hospital stay.
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Objective With the recent aging trend in the Japanese population, dysphagia appears to be increasing. However, few epidemiologic surveys have been conducted to determine the prevalence of dysphagia in local inhabitants. Ohkuma et al. prepared a highly reliable questionnaire using a simple test and safe examination method. We investigated the presence/absence of symptoms of dysphagia in local inhabitants, evaluated their association with subjective symptoms, and examined whether the inhabitants were following a particular diet, which is the most important factor in management of dysphagia. Methods A cross-sectional study involving 743 inhabitants (age: over 20) of an isolated island was performed. Each subject was asked basic questions (awareness about the presence/absence of dysphagia and dietary habits), and the data was analyzed by chi-square test. Based on their responses, dysphagia incidence was determined and rated on a 3-category scale (severe, mild, and no dysphagia). Results Responses were recollected from 368 subjects (response rate, 49.5%). The percentage of subjects aware of dysphagia in the severe, mild, and no dysphagia groups was 13.8%, 3.2%, and 0%, respectively and the percentage of subjects who changed their dietary habits was 17.2%, 2.6%, and 0%. These percentages were significantly higher in the severe group than in the mild and no dysphagia groups, though the value was less than 20% in the 3 groups. Conclusion Most subjects in the present study were unaware of dysphagia, suggesting that patients with dysphagia tend to be unaware of the key symptoms of dysphagia.
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