Dysphagia screening and pneumonia after subarachnoid hemorrhage: Findings from the Chinese stroke center alliance

Background and Purpose Dysphagia is common and is associated with aspiration pneumonia. However, little is known about the prevalence of and factors influencing dysphagia screening (DS) and pneumonia after subarachnoid hemorrhage (SAH). Methods We used data on SAH patients admitted to 1476 hospitals from the China Stroke Center Alliance (CSCA) from August 2015 to July 2019 to analyze the rates of DS and pneumonia. We then conducted univariate and multivariable analyses to examine the relationship between DS and pneumonia. Results Among 4877 SAH patients who were eligible for DS and had complete data on pneumonia status, 3527 (72.3%) underwent DS, and 1006 (20.6%) developed pneumonia. Compared with patients without pneumonia, patients with pneumonia were older (mean: 63.4 vs. 57.8 years of age), had lower Glasgow Coma Scale (GCS) scores at admission (mean: 13.5 vs. 14.3), were more likely to have dysphagia (15.2% vs. 3.3%), and were more likely to have undergone aneurysm isolation (19.1% vs. 10.0%). In multivariable analyses, factors independently associated with a higher risk of pneumonia were dysphagia [odds ratio (OR), 3.77; 95% confidence interval (CI), 2.85–4.98], age (OR, 1.50 per 10‐year increase; 95% CI, 1.40–1.60), male sex (OR, 1.23; 95% CI, 1.02–1.49), arrival at the hospital by emergency medical services (OR, 1.36; 95% CI, 1.16–1.58), nimodipine treatment (OR, 1.42; 95% CI, 1.11–1.81), endovascular embolization of aneurysms (OR, 1.23; 95% CI, 1.03–1.47), cerebral ventricular shunt placement (OR, 2.24; 95% CI, 1.41–3.54), and treatment at a higher grade hospital (OR, 1.44; 95% CI, 1.21–1.71). Conclusion More than a quarter of patients with SAH did not have documented DS, while one‐fifth developed pneumonia. DS performance was associated with a lower risk of pneumonia. Randomized controlled trials may be needed to determine the effectiveness of DS. Among 4877 SAH patients who were eligible for DS and had complete data on pneumonia status from the China Stroke Center Alliance, 3527 (72.3%) underwent DS, and 1006 (20.6%) developed pneumonia. Dysphagia was the most significant predictor of pneumonia. In order to reduce the rate of in‐hospital pneumonia among stroke patients, standardized management strategies for dysphagia should be refined.