Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Clin Interv Aging. 2022 Mar 17;17:295-308. doi: 10.2147/CIA.S346824. eCollection 2022.
To investigate the effectiveness of dysphagia screening and subsequent swallowing rehabilitation in elderly stroke patients with malnutrition risk.
Based on the Chinese Stroke Center Alliance (CSCA) from August 1, 2015 to July 21, 2019, we compared the in-hospital adverse outcomes among stroke patients (including ischemic stroke, intracranial hemorrhage, and subarachnoid hemorrhage) over 70 years old with and without dysphagia screening. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were the composite endpoint of discharge against medical advice (DAMA) or in-hospital death.
Among 365,530 stroke patients ≥ 70 years old with malnutrition risk in the CSCA, documented dysphagia screening was performed for 288,764 (79.0%) participants. Of these, 41,482 (14.37%) patients had dysphagia, and 33,548 (80.87%) patients received swallowing rehabilitation. A total of 1,694 (0.46%) patients experienced in-hospital death. After adjustment for traditional risk factors, dysphagia screening was associated with a low risk of all-cause mortality in stroke patients [adjusted odds ratio (aOR): 0.75, 95% confidence interval (CI):0.65-0.87]. Compared to patients with dysphagia who did not receive swallowing rehabilitation, patients reveiving swallowing rehabilitation had a reduced risk of in-hospital death (aOR:0.39, 95% CI: 0.33-0.46). Additionally, dysphagia screening had a lower risk for the composite endpoint of DAMA or in-hospital death (aOR:0.83,95% CI: 0.80-0.87), as did subsequent swallowing rehabilitation (aOR:0.43,95% CI: 0.40-0.47). Similar results were observed in the sensitivity analysis through inverse probability of treatment weighting, propensity score matching, and excluding patients without National Institutes of Health Stroke Scale scores. A similar association was observed between dysphagia management and adverse clinical outcomes in ischemic stroke and intracranial hemorrhage patients.
Dysphagia screening and swallowing rehabilitation were associated with a reduced risk of in-hospital death and composite outcome of DAMA or in-hospital death for stroke patients with malnutrition risk. Future research should concentrate on improving the quality of medical care for dysphagia management to improve patients' outcomes.
调查吞咽困难筛查及随后的吞咽康复对有营养不良风险的老年脑卒中患者的疗效。
基于中国卒中中心联盟（CSCA），我们比较了 2015 年 8 月 1 日至 2019 年 7 月 21 日期间 70 岁以上伴有或不伴有吞咽困难筛查的脑卒中患者（包括缺血性脑卒中、颅内出血和蛛网膜下腔出血）的住院不良结局。主要结局为院内全因死亡率。次要结局为出院医嘱不遵从或院内死亡的复合终点。
在 CSCA 中，365530 名 70 岁以上有营养不良风险的脑卒中患者中，有 288764 名（79.0%）接受了吞咽困难筛查。其中，41482 名（14.37%）患者有吞咽困难，33548 名（80.87%）患者接受了吞咽康复。共有 1694 名（0.46%）患者发生院内死亡。调整传统危险因素后，吞咽困难筛查与脑卒中患者的全因死亡率降低相关（校正比值比[aOR]：0.75，95%置信区间[CI]：0.65-0.87）。与未接受吞咽康复的吞咽困难患者相比，接受吞咽康复的患者院内死亡风险降低（aOR：0.39，95%CI：0.33-0.46）。此外，吞咽困难筛查降低了出院医嘱不遵从或院内死亡的复合终点风险（aOR：0.83，95%CI：0.80-0.87），吞咽康复也降低了该复合终点风险（aOR：0.43，95%CI：0.40-0.47）。通过逆概率处理加权、倾向评分匹配和排除无国立卫生研究院卒中量表评分的患者进行敏感性分析，也观察到了类似的结果。在缺血性卒中和颅内出血患者中，吞咽困难管理与不良临床结局之间也存在类似的关联。
吞咽困难筛查和吞咽康复可降低有营养不良风险的脑卒中患者的院内死亡风险和出院医嘱不遵从或院内死亡的复合结局风险。未来的研究应集中于提高吞咽困难管理的医疗质量，以改善患者结局。
