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Food and health

Impact of delay in early swallow screening on pneumonia, length of stay in hospital, disability and mortality in acute stroke patients

European Journal of Clinical Nutrition volume 72, pages 1548–1554 (2018)Cite this article

Subjects

Abstract

Background/Objectives

Early swallow screening, within 4 h of admission, is required for all acute stroke patients to commence nutritional support, as recommended. We evaluated the impact of delay in early swallow screening on outcomes in patients admitted with acute stroke.

Subjects/Methods

Prospective cohort study of 1656 men (mean ± SD age = 73.1y ± 13.2) and 1653 women (79.3y ± 13.0) admitted with stroke to hyperacute stroke units (HASUs) in Surrey. Logistic regression was used to assess the risk (adjusted for age, stroke severity and co-morbidities) of delay in swallow screening on pneumonia, length of stay (LOS) > 3 weeks in HASU or hospital, moderately severe to severe disability on discharge (modified Rankin scale score = 4–5) and mortality during admission.

Results

Compared with those who received swallow screening within 4 h of admission, a delay between 4 and 72 h was associated with greater risks of pneumonia: OR = 1.4 (95%CI:1.1–1.9, P = 0.022), moderately severe to severe disability on discharge: OR = 1.4 (1.1–1.7, P = 0.007) and a delay beyond 72 h was associated with even greater risks of pneumonia: OR = 2.3 (1.4–3.6, P < 0.001), prolonged LOS in HASU: OR = 1.7 (1.0–3.0, P = 0.047, median LOS = 6.2 vs. 14.7 days) and hospital: OR = 2.1-fold (1.3–3.4, P = 0.007, median LOS = 6.8 vs. 14.9 days), moderately severe to severe disability on discharge: OR = 2.5 (1.7–3.7, P < 0.001) and mortality: OR = 3.8 (2.5–5.6, P < 0.001). These risks persisted after excluding 103 patients who died within 72 h.

Conclusions

Delay in early screening for swallow capacity in acute stroke patients is detrimental to outcomes, possibly due to delaying nutritional provision or through inappropriate feeding leading to aspiration. Routine early screening needs greater attention in HASUs.

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Acknowledgements

We are grateful to all patients who participated in this SSNAP audit and to Dr Adrian Blight (currently at Department of Stroke, St George’s University Hospitals NHS Foundation Trust) for his help with contribution of data from Royal Surrey County Hospital.

Author contributions

TSH and PS designed research (project conception, development of overall research plan and study oversight). BA, GG, TP, CB, PK and AB conducted data collection. TSH analysed the data and wrote the first draft of the paper and MEJL and PS edited subsequent versions of the paper. TSH had primary responsibility for final content. All authors reviewed and approved the final version of the paper.

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Authors and Affiliations

  1. Institute of Cardiovascular Research, Royal Holloway, University of London, London, UK

    Thang S Han, Tasmin Patel, Sapna Sharma & Pankaj Sharma

  2. Department of Endocrinology, Ashford and St Peter’s NHS Foundation Trust, Chertsey, UK

    Thang S Han

  3. Department of Nutrition, School of Medicine, University of Glasgow, Glasgow, UK

    Michael EJ Lean

  4. Department of Cardiology, Ashford and St Peter’s NHS Foundation Trust, Chertsey, UK

    David Fluck

  5. Department of Stroke, Ashford and St Peter’s NHS Foundation Trust, Chertsey, UK

    Brendan Affley & Giosue Gulli

  6. Department of Stroke, NHS Frimley Health Foundation Trust, Frimley, UK

    Christopher Barrett

  7. Department of Stroke, Epsom and St Helier University Hospitals, Epsom, UK

    Puneet Kakar

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  1. Thang S Han
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Correspondence to Thang S Han.

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Han, T.S., Lean, M.E., Fluck, D. et al. Impact of delay in early swallow screening on pneumonia, length of stay in hospital, disability and mortality in acute stroke patients. Eur J Clin Nutr 72, 1548–1554 (2018). https://doi.org/10.1038/s41430-018-0148-4

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