American Speech-Language-Hearing Association

EBP Compendium: Summary of Systematic Review

Agency for Healthcare Research and Quality
Prevention of Pneumonia in Elderly Stroke Patients by Systematic Diagnosis and Treatment of Dysphagia: An Evidence-Based Comprehensive Analysis of the Literature

Doggett, D. L., Tappe, K. A., et al. (2001).
Dysphagia, 16(4), 279-295.

Indicators of Review Quality:

The review addresses a clearly focused question Yes
Criteria for inclusion of studies are provided Yes
Search strategy is described in sufficient detail for replication Yes
Included studies are assessed for study quality Yes
Quality assessments are reproducible Yes

Description: This is a review of clinical trials investigating the systematic diagnosis and treatment of elderly stroke patients.

Question(s) Addressed:

  1. Does use of non-instrumental exams in an acute care stroke dysphagia program reduce pneumonia rates?
  2. Does use of videofluoroscopic study of swallowing (VFSS) in an acute care stroke dysphagia program reduce pneumonia rates?
  3. Whether use of fiberoptic endoscopic evaluation of swallowing (FEES) in a dysphagia program in the rehabilitation setting reduces pneumonia rates.

Population: Elderly stroke patients, not otherwise described

Intervention/Assessment: Instrumental and non-instrumental, including VFSS and FEES

Number of Studies Included: Not stated

Years Included: Through 1998

Findings:

Conclusions:

  • Assessment/Diagnosis
    • Assessment Instruments
      • Swallowing
        • The authors found that non-instrumental examination, videoflouroscopic imaging and fiberoptic endoscopic examination all demonstrated reduction in pneumonia rates. No studies allowed any meaningful comparisons to determine efficacy of different diagnostic tools.
        • The evidence indicates that implementation of a systematic program of diagnosis and treatment of dysphagia in an acute stroke management plan may yield dramatic reductions in pneumonia rates. Because these data are derived from historically controlled studies rather than randomized controlled trials, the exact magnitude of this reduction is difficult to determine.
  • Treatment
    • Swallowing
      • It is difficult to "determine the contribution of the dysphagia-specific aspects of the management programs to these [pneumonia] rate reductions. However, because the effects observed in these studies are substantial, it would be imprudent to ignore them, especially since these programs appear to have a minimal potential to harm patients" (p. 294).

Keywords: Stroke, Swallowing Disorders

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Added to Compendium: March 2012

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