|
[Date Prev][Date Next]
[Chronological]
[Thread]
[Top]
[Dysphagia] CVA Research
Hi Chris
Here's another one for you:
Aslanyan, S., et al., Pneumonia and urinary tract infection after acute ischaemic stroke: a tertiary analysis of the GAIN International trial. Eur J Neurol, 2004. 11(1): p. 49-53.
Abstract:
The third most common stroke complication is infection. We studied the rates of aspiration pneumonia and urinary tract infection (UTI), their risk factors and their effect on outcome in the 1455 Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International patients with ischaemic stroke. Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7, after correcting for prognostic factors. Higher baseline National Institute of Health Stroke Scale (NIHSS) and age, male gender, history of diabetes and stroke subtype predicted pneumonia, which occurred in 13.6% of patients. Female gender and higher baseline NIHSS and age predicted UTI, which occurred in 17.2% of patients. Pneumonia was associated with poor outcome by mortality (hazard ratio, 2.2; 95% confidence interval, 1.5-3.3), Barthel index (<60) (odds ratio, 3.8; 2.2-6.7), NIHSS (4.9; 1.7-14) and Rankin scale (>/=2) (3.4; 1.4-8.3). UTI was associated with Barthel index (1.9; 1.2-2.9), NIHSS (2.2; 1.2-4.0) and Rankin scale (3.1; 1.6-4.9). Pneumonia and UTI are independently associated with stroke poor outcome. Patients with identified risk factors must be closely monitored for infection.
Regards the NPO for aspirin; it can be administered PR..................
Best regards,
Claire
----- Original Message -----
From: <wwasmith@comcast.net>
To: "Christopher Babashka" <Christopher.Babashka@stalexius.net>; <dysphagia@b9.com>
Sent: Tuesday, June 14, 2005 4:29 AM
Subject: Re: [Dysphagia] CVA Research
> Hi Chris,
>
> Here's a couple I pulled out:
>
> Gordon, C, Langton-Hewer R, Wade DT. Dysphagia in acute stroke. British Medical Journal, 1987;295;411-414. Showed that 19% of CVA patients with dysphagia developed pneumonia compared with 8% of CVA patients without dysphagia, altho the difference did not reach statistical significance.
>
> There are lots of studies that correlate stroke with aspiration (which of course is one way to reach pneumonia) Ding R, Logemann JA, Pneumonia in Stroke Patients: A retrospective study. Dysphagia, 2000; 15; 51-57, between 48 and 55% of the 277 consectively studied patients aspirated. Pneumonia was correlated with a higher incidence of HTN, diabetes.
>
> Try this also: Schmidt J., Holas M., halvorson, K, Reding M. (1994). Dysphagia, 9, 7-11. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. I just reviewed the abstract which didn't give any details.
>
> Is the patient being anticoagulated with some drug other than aspiran (via a nonoral route)? Heparin? Coumadin? Then probably the low dose aspiran is not needed, and skipping a day or so (until you get there, which he/she clearly thinks will be soon!) has not been deemed harmful by the neurologist for the recurrance of a subsequent stroke. Swallowing water (with a baby aspiran) will wash all the flora in the mouth into the lungs if the patient is aspirating, and without adequate oral hygiene, that's a setup for a pneumonia. Are there other diagnoses that the MD is factoring into his/her decision?
>
> If the patient is newly admitted and swelling in the brain hasn't maxed yet (at 72 hours, if I recall correctly) the patient may get slightly worse before recovery commences.
>
> Wendy
>
> --
> Wendy Avery-Smith, MS, OTR/L
> 8A Florence St.
> Andover MA 01810
> (978) 475-3545
>
> WWASmith@comcast.net
>
>
> > Good Morning,
> > During a discussion with one of our neurologist he said "The leading
> > cause of death once a patient gets to the hospital after an acute CVA is
> > aspiration pneumonia" and that "Early administration of PO aspirin in
> > acute CVA does not have any effect on long-term outcomes, so they can be
> > STRICT npo until speech sees them!!!!!!!!"
> >
> > I have searched and asked the neurologist for sources. Does anyone
> > have any references that may prove or disprove these statements?
> >
> > Thank you in advance,
> > Chris Babashka
> >
> > _______________________________________________
> > Dysphagia mailing list
> > Dysphagia@b9.com
> > http://lists.b9.com/mailman/listinfo/dysphagia
> _______________________________________________
> Dysphagia mailing list
> Dysphagia@b9.com
> http://lists.b9.com/mailman/listinfo/dysphagia
|
|