Prevention of pneumonia in elderly stroke patients by systematic diagnosisand treatment of dysphagia: An evidence-based comprehensive analysis of the literature

We conducted a systematic literature review and analysis of programs for ev aluating swallowing in order to prevent aspiration pneumonia. This article derives from an evidence report on diagnosis and treatment of swallowing di sorders (dysphagia) in acute-car stroke patients prepared by us as an Evide nce-based Practice Center (EPC) under contract to the U.S. Agency for Healt hcare Research and Quality (AHRQ). Available evidence on the diagnosis and treatment of dysphagia for preventing pneumonia is limited. We found report ed pneumonia rates in one historical controlled study of a program using be dside exams (BSE) for acute stroke patients, one uncontrolled case series s tudy of acute stroke patient-reporting of swallowing difficulty, one contro lled case series study of videofluoroscopic study of swallowing (VFSS) for acute stroke patients; and one historical controlled study of fiberoptic en doscopic examination of swallowing (FEES) for patients referred for swallow ing evaluation in rehabilitation centers. Comparing these results with hist orical controls indicates that implementation of dysphagia programs is acco mpanied by substantial reductions in pneumonia rates. While all these metho ds appeared effective, the small sizes of available studies did not allow d etermination of the relative efficacy of BSE, VFSS, or FEES.