Nicky Baxter

Nicky has recently started working as a geriatrician for Nelson Marlborough District Health Board and undertook this research whilst working as a geriatric registrar at Dunedin Hospital.

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Delay To Dysphagia Screening In Acute Stroke And Rates Of Medical Complications In A New Zealand Hospital​

Aims: Delay to dysphagia screening is associated with increased rates of stroke-associated pneumonia (SAP).1 It may delay patients receiving usual medications or oral fluids, and increase the risk of other medical complications. We examined whether there is an association between delays to dysphagia screening in acute stroke and rates of SAP, acute kidney injury (AKI), fluid overload and severe hypertension.

Method: This retrospective cohort study evaluated 149 patients admitted to Dunedin Hospital with acute stroke, over 10 months (starting January 2018), excluding patients who were intubated or managed palliatively in the first 24 hours. Patients with a delay to dysphagia screening (>4 hours or no dysphagia screen) were compared to those with dysphagia screening ≤4 hours.

Results: 23% had a dysphagia screen within 4 hours and 9% had no dysphagia screen. Median time to dysphagia screening was 16.5 hours in the delayed and 2 hours in the ≤4-hour group. The rates of the primary outcomes were 14% SAP, 7% AKI and fluid overload, and 13% severe hypertension, with no statistically significant difference between groups. Comparing the highest quartile (>21 hours) to the lowest quartile (≤4 hours), there was no statistically significant difference for SAP (30% vs. 12%, OR 3.26), AKI (9% vs. 3%, OR 3.30), fluid overload (6% vs. 8%, OR 0.67), or severe hypertension (18% vs. 6%, OR 3.56). 

Conclusions: This study did not show a significant association between a delay to dysphagia screening and SAP, AKI, fluid overload or severe hypertension. The absolute difference between the highest and lowest quartile for SAP, AKI and severe hypertension suggests that larger scale studies will be beneficial for future dysphagia research.

References:
1. Bray, BD. 2017. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry, 88(1): 25-30.