One-Year Risk of Pneumonia and Mortality in Patients with Poststroke Dysphagia: A Nationwide Population-Based Study

doi:10.1016/j.jstrokecerebrovasdis.2017.12.017

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Title:	One-Year Risk of Pneumonia and Mortality in Patients with Poststroke Dysphagia: A Nationwide Population-Based Study
Authors:	Ho, Chung-Han Lin, Wen-Chih Hsu, Ya-Fang Lee, I-Hui Hung, Yi-Chieh
Contributors:	Chi Mei Med Ctr, Dept Med Res Chia Nan Univ Pharm & Sci, Dept Hosp & Hlth Care Adm Chi Mei Med Ctr, Dept Phys Med & Rehabil Hung Surg Hosp, Dept Phys Med & Rehabil Taipei Vet Gen Hosp, Dept Neurol Natl Yang Ming Univ, Inst Brain Sci Chi Mei Med Ctr, Div Neurosurg, Dept Surg Chia Nan Univ Pharm & Sci, Dept Recreat & Healthcare Management
Keywords:	Mortality nasogastric tube poststroke dysphagia pneumonia population based study
Date:	2018-05
Issue Date:	2019-11-15 15:44:48 (UTC+8)
Publisher:	ELSEVIER SCIENCE BV
Abstract:	Background: In the early stages of stroke, the use of a nasogastric tube can reduce complications such as malnutrition, dehydration, and pneumonia. However, its long-term efficacy is controversial. Methods: This retrospective cohort study used Taiwan's National Health Insurance Research Database to investigate associations among dysphagia, rate of readmission due to pneumonia, and mortality 1 year after stroke. Patients who had received their first stroke diagnosis and inpatient rehabilitation from January 1, 2006, to December 31, 2010, were enrolled. The presence of dysphagia was determined by the number of nasogastric tubes received (>= 2 was classified as dysphagia, < 2 as control). Kaplan-Meier plots with log-rank tests revealed differences between the 2 groups, and a Cox regression model was used to estimate the hazard ratio. Results: There were 5032 patients in the dysphagia group and 52,323 patients in the control group. The dysphagia group had a higher probability and incidence of pneumonia (18.78% versus 6.52%, P <.001 and adjusted hazard ratio [AHR] = 2.00, 95% confidence interval [CI] = 1.84-2.16) and a higher mortality rate (10.45% versus 4.77%, P <.001; AHR = 1.61, 95% CI = 1.46-1.79) 1 year after stroke. Conclusions: The association persisted until the 5-year poststroke time point. Our results suggest that prolonged nasogastric tube use has negative effects. Intensive evaluation of dysphagia and removal of the nasogastric tube in the early stages of stroke might reduce pneumonia incidence and mortality. (c) 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.
???metadata.dc.relation.uri???:	http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.12.017
Relation:	Information & Management, v.27, n.5, pp.1311-1317
Appears in Collections:	[Dept. of Hospital and Health (including master's program)] Periodical Articles [Dept. of Recreation and Health-Care Management] Periodical Articles

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