Detecting Swallowing Problems Prevents Pneumonia

NEW YORK (Reuters Health) - The rate of pneumonia is lower in hospitals that have formal screening programs to detected swallowing difficulties (dysphagia) in stroke patients, investigators in the United States report. They say a screening program could prevent thousands of pneumonia cases and deaths.

Besides not receiving proper nutrition, stroke patients with dysphagia are at risk for inhaling food or liquid when they try to eat, which can lead to aspiration pneumonia, a serious complication. Several published guidelines recommend that a swallow evaluation be performed for stroke patients before they try to eat, Dr. Judith A. Hinchey, of Tufts-New England Medical Center in Boston, and associates note.

For their study, published in the medical journal Stroke, Hinchey's group reviewed records of 2,532 patients treated for stroke between 2001 and 2003 at 15 healthcare institutions.

Six of the 15 sites had a formal dysphagia screening program. Dysphagia screening was conducted in 78 percent of patients at sites with screening programs, versus 56 percent at sites with no formal program.

At hospitals with no formal program, screening was more likely among patients with higher stroke scores, suggesting that "hospitals with a formal program include screening on all patients, whereas other hospitals may only think of performing a screen on patients who, by intuitive criteria, are at higher risk of pneumonia."

Pneumonia rates were significantly lower at sites that had formal written protocols, 2.4 percent versus 5.4 percent. The authors found that having a formal screening protocol decreased the odds of pneumonia by three-fold after accounting for stroke severity.

"If instituting a formal dysphagia screening protocol prevented just one half of the poststroke pneumonias," the investigators say, "it could save nearly 8,300 lives and prevent nearly 40,000 pneumonias per year (based on 700,000 strokes per year)."

SOURCE: Stroke, September 2005.