This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Reynolds, P. S. Articles by Tegeler, C. H. Search for Related Content PubMed Articles by Reynolds, P. S. Articles by Tegeler, C. H. Social Bookmarking                         What's this?

Pneumonia in Dysphagic Stroke Patients: Effect on Outcomes and Identification of High Risk Patients

Laura Gilbert, Med

David C. Good, MD

Volker A. Knappertz, MD

Cheryl Crenshaw, MSN

Stephen L. Wayne, MD

David Pillbury, MA

Charles H. Tegeler, MD

Objectives : To identify variables associated with the development of pneumonia in patients with ischemic stroke and to assess the utility of both the clinical swallowing examination and the videofluoroscopic modified barium swallow (VMBS) to identify stroke patients at risk for aspiration and subsequent pneumonia and to measure the effect of pneumonia on hospital outcomes.

Design/Methods: Bedside clinical evaluation and VMBS were performed on 102 patients admitted with acute ischemic stroke who were referred for swallowing eval uation because of clinical suspicion of dysphagia. The clinical features, stroke loca tion and severity, pneumonia, length of stay (LOS), mortality, and costs were evalu ated retrospectively.

Results: Pneumonia occurred in 21 of 102 patients (20.6%) and was more fre quent in those with aspiration on VMBS (p < 0.01). Those with pneumonia had longer median LOS (29 days vs. 10 days), higher total costs ($27,764 vs. $9,753, p < 0.0001), higher mortality (24 percent vs. 3.7 percent, p < 0.01), and worse 24-hour stroke severity scores (p = 0.001).

The VMBS correlated better with developing pneumonia than did the clinical swallowing assessment alone, but the combined use of both tests yielded the highest sensitivity (0.86) and a negative predictive value (0.91) for pneumonia.

Conclusions: Pneumonia complicating ischemic stroke significantly correlates with increased mortality, increased LOS, higher costs, and 24-hour stroke severity scores. Pneumonia was more frequent in patients who aspirated on VMBS and in pa tients who had an impaired level of consciousness. The combined use of clinical swal lowing evaluation and VMBS has high negative predictive value in assessing risk for pneumonia.

Key Words: Stroke • Dysphagia • Aspiration • Pneumonia • Outcome measures.

Neurorehabilitation and Neural Repair, Vol. 12, No. 1, 15-21 (1998)
DOI: 10.1177/154596839801200103


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?