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Dysphagia Screening and Intensified Oral Hygiene Reduce Pneumonia After Stroke

Sørensen, Rikke Terp; Rasmussen, Rune Skovgaard; Overgaard, Karsten; Lerche, Axel; Johansen, Ann Mosegaard; Lindhardt, Tove

Journal of Neuroscience Nursing: June 2013 - Volume 45 - Issue 3 - p 139–146
doi: 10.1097/JNN.0b013e31828a412c
Article

ABSTRACT: Objectives: Dysphagia occurs in approximately 51%–78% of patients with acute stroke. The incidence of pneumonia caused by aspiration in dysphagic patients increases both mortality and the need for hospitalization. The aim of this study was to investigate whether the incidence of aspiration pneumonia could be reduced in such patients by an early screening for dysphagia and intensified oral hygiene. Material and Methods: In this controlled trial, 146 hospitalized acute stroke patients with moderate or severe dysphagia were included in three groups: an intervention group (n = 58), one internal control group (n = 58, retrospectively selected from same clinic), and one external control group (n = 30) from a comparable stroke unit in a neighboring hospital. The intervention consisted of early screening with a clinical method of dysphagia screening, the Gugging Swallowing Screen, and intensified oral hygiene. Results: The incidence of x-ray verified pneumonia was 4 of 58 (7%) in the intervention group compared with 16 of 58 (28%) in the internal control group (p < .01) and with 8 of 30 (27%) in the external control group (p < .05). Conclusions: Early and systematic dysphagia screening by the Gugging Swallowing Screen method and intensified oral hygiene reduced the incidence of x-ray verified pneumonia.

Rune Skovgaard Rasmussen, MA PhD, is an Associate Professor of General Pathology and a Neuropsychologist at the Department of Neurology, University Hospital of Copenhagen, Herlev Hospital, Denmark.

Karsten Overgaard, MD, is an Associate Professor, DLS (Diploma in Leadership Sciences), Head of Stroke Unit & Research, and a Consultant Neurologist at the Department of Neurology, University Hospital of Copenhagen, Herlev Hospital, Denmark.

Axel Lerche, MD, is a Senior Registrar and Specialist in Internal Medicine at the Department of Internal Medicine, University Hospital of Copenhagen, Gentofte Hospital, Denmark.

Ann Mosegaard Johansen, RN SD (Diploma of Health), is a Senior Nurse at the Department of Rheumatology, Department C, University Hospital of Copenhagen, Gentofte Hospital, Denmark.

Tove Lindhardt, MScN DMSc, is a Senior Researcher at the University Hospital of Copenhagen, Herlev Hospital, Denmark.

Questions or comments about this article may be directed to Rikke Terp Sørensen, RN, at rikke.terp.soerensen@regionh.dk. She is a Clinical Nurse Specialist at the Stroke Unit, Department C, University Hospital of Copenhagen, Gentofte Hospital, Denmark.

Conflict of interest and sources of funding statement: There are no conflicts of interest. This investigation was financially supported by the Lundbeck Foundation, the Tryg Foundation, and the Aase and Ejnar Danielsen Foundation.

© 2013 American Association of Neuroscience Nurses