Clinical outcomes for patients with dysphagia following stroke in New Zealand

Abstract

Significant health issues and service delivery costs are associated with dysphagia following stroke. This prospective cohort study identifies characteristics and outcomes associated with dysphagia secondary to stroke in New Zealand. These data are discussed in reference to data from the National Acute Stroke Services Audit 2009 and published international data. Patients consecutively referred for a swallowing evaluation at four urban hospitals in New Zealand were invited to participate. Characteristics of 311 patients with dysphagia following acute stroke were collected and outcomes were measured at 3 months post stroke. Mortality rates were 16% and pneumonia rates 27%. Mean length of stay was 24 days and only 45% of patients were in their own home at three months post stroke. Pneumonia was significantly associated with mortality (P < 0.0001) and increased length of stay (P < 0.0001). Only 13% of patients received referral for instrumental assessment of swallowing. In conclusion, the outcomes for stroke patients with dysphagia in New Zealand are poor with a high risk of pneumonia and long hospital stays. Multidisciplinary acute stroke service teams need clear clinical pathways to reduce mortality and pneumonia rates for these high-risk patients with dysphagia.

Keywords:

• Dysphagia
• Stroke
• Clinical outcomes
• Pneumonia
• Speech-language pathology
• New Zealand