Impact of Dysphagia Assessment and Management on Risk of Stroke-Associated Pneumonia: A Systematic Review

Background: Patients with dysphagia are at an increased risk of stroke-associated pneumonia. There is wide variation in the way patients are screened and assessed during the acute phase. The aim of this review was to identify the methods of assessment and management in acute stroke that influence the risk of stroke-associated pneumonia. Studies of stroke patients that reported dysphagia screening, assessment or management and occurrence of pneumonia during acute phase stroke were screened for inclusion after electronic searches of multiple databases from inception to November 2016. The primary outcome was association with stroke-associated pneumonia. Summary: Twelve studies of 87,824 patients were included. The type of dysphagia screening protocol varied widely across and within studies. There was limited information on what comprised a specialist swallow assessment and alternative feeding was the only management strategy, which was reported for association with stroke-associated pneumonia. Use of a formal screening protocol and early dysphagia screening (EDS) and assessment by a speech and language pathologist (SLP) were associated with a reduced risk of stroke-associated pneumonia. There was marked heterogeneity between the included studies, which precluded meta-analysis. Key Messages: There is variation in the assessment and management of dysphagia in acute stroke. There is increasing evidence that EDS and specialist swallow assessment by an SLP may reduce the odds of stroke-associated pneumonia. There is the potential for other factors to influence the incidence of stroke-associated pneumonia during the acute phase.

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Abstract P068: Obstructive Sleep Apnea is Associated with an Increase Risk of Osteoporosis

Circulation ◽

10.1161/circ.131.suppl_1.p068 ◽

2015 ◽

Vol 131 (suppl_1) ◽

Author(s):

Anawin Sanguankeo ◽

Sikarin Upala

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Primary Outcome ◽

Meta Analysis ◽

Systemic Disease ◽

Obstructive Sleep ◽

Increased Risk ◽

Increase Risk ◽

Osteoporosis Risk ◽

Stimulation Of

Background: Obstructive sleep apnea (OSA) is thought to be a systemic disease and has been associated with many disorders such as metabolic, endocrine, and especially cardiovascular diseases. One of the consequences of OSA is hypoxia, which can lead to a reduction in growth of osteoblast and a stimulation of osteoclast. Our meta-analysis was conducted to determine the risk of osteoporosis in patients with OSA compared to controls. Objectives: Eligible studies assessing the effects of obstructive sleep apnea on osteoporosis risk were comprehensively searched in PubMed/MEDLINE, EMBASE, and CENTRAL from their inception to September 2014. Two authors independently assessed article quality and extracted the data. Primary outcome were number of participants, prevalence, or risk ratio of osteoporosis in OSA and controls. Results: From 40 full-text articles, 3 studies involving 113,090 participants were included in the meta-analysis that were based on the random effects model. Compared with controls, participants who were diagnosed with obstructive sleep apnea had increased risk of osteoporosis (pooled risks ratio, 1.85; 95% CI, 1.34, 2.56). Conclusion: Patients with OSA had a higher risk of developing osteoporosis. Further study is needed to evaluate the possible mechanisms between these two conditions and to find potential treatment for OSA that could prevent osteoporosis.

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A Systematic Review and Meta-Analysis of Molecular Biomarkers Associated with Early Neurological Deterioration Following Acute Stroke

Cerebrovascular Diseases ◽

10.1159/000495572 ◽

2018 ◽

Vol 46 (5-6) ◽

pp. 230-241 ◽

Cited By ~ 10

Author(s):

Alexander J. Martin ◽

Christopher I. Price

Keyword(s):

Ischaemic Stroke ◽

Acute Stroke ◽

Fixed Effects ◽

Meta Analysis ◽

Density Lipoprotein ◽

High Sensitivity ◽

Neurological Status ◽

Neurological Deterioration ◽

Increased Risk ◽

Early Neurological Deterioration

Background: Early neurological deterioration (END) following acute stroke is associated with poorer long-term outcomes. Identification of patients at risk could assist early monitoring and treatment decisions. This review summarised the evidence describing non-radiological biomarkers for END. Summary: Electronic searches from January 1990 to March 2017 identified studies reporting a blood/cerebrospinal fluid (CSF)/urine biomarker measurement within 24 h of acute stroke and at least 2 serial assessments of clinical neurological status (< 24 h and < 7 days). Out of 12,895 citations, 82 studies were included, mostly focusing on ischaemic stroke. Using higher neurological thresholds, the n-weighted END incidence for ischaemic stroke was 11.9% (95% CI 11.4–12.4%) and 18.6% (17.9–19.2%) for lower thresholds. Incidence decreased with advancing study publication year (Pearson r-squared 0.23 and 0.15 for higher and lower threshold studies). After classification into 3 broad categories, meta-analysis showed that biomarkers associated with increased END risk (n; fixed-effects mean difference; 95% CI) were “metabolic” (glucose [n = 9,481; 0.90 mmol/L; 0.74–1.06], glycosylated haemoglobin [n = 3,146; 0.33%; 0.19–0.46], low-density lipoprotein [n = 4,839; 0.13 mmol/L; 0.06–0.21], total cholesterol [n = 4,762; 0.21 mmol/L; 0.11–0.31], triglycerides [n = 4,820; 0.11 mmol/L; 0.06–0.17], urea [n = 1,351; 0.55 mmol/L; 0.14–0.96], decreasing albumin [n = 513; 0.33 g/dL; 0.05–0.61]); “inflammatory and excitotoxic” (plasma glutamate [n = 688; 60.13 µmol/L; 50.04–70.22], CSF glutamate [n = 369; 7.50 µmol/L; 6.76–8.23], homocysteine [n = 824; 2.15 µmol/L; 0.68–3.61], leucocytes [n = 3,766; 0.54 × 109/L; 0.34–0.74], high-sensitivity C-reactive protein [n = 1,707; 3.79 mg/L; 1.23–6.35]); and “coagulation/haematological” (fibrinogen [n = 3,132; 0.32 g/L; 0.25–0.40]; decreasing haemoglobin [n = 3,586; 2.38 g/L; 0.15–4.60]). Key Messages: Declining incidence of END may represent improving care standards; however, it remains a frequent occurrence. Although statistical associations exist between biomarkers and an increased risk of END, the most promising still need prospective evaluation to determine their additional value relative to baseline radiological and clinical characteristics.

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Higher Levels of C-Reactive Protein in the acute phase of stroke Indicate an Increased Risk for Post-stroke Depression: A Systematic Review and Meta-Analysis

Neuroscience & Biobehavioral Reviews ◽

10.1016/j.neubiorev.2021.08.018 ◽

2021 ◽

Author(s):

Yu Yang ◽

Lijun Zhu ◽

Beilin Zhang ◽

Jiguo Gao ◽

Teng Zhao ◽

...

Keyword(s):

Systematic Review ◽

Acute Phase ◽

Meta Analysis ◽

C Reactive Protein ◽

Post Stroke ◽

Reactive Protein ◽

Increased Risk ◽

Post Stroke Depression

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Assessment and Management of Dysphagia in Acute Stroke: An Initial Service Review of International Practice

Geriatrics ◽

10.3390/geriatrics5010004 ◽

2020 ◽

Vol 5 (1) ◽

pp. 4

Author(s):

Carol A. Fairfield ◽

David G. Smithard

Keyword(s):

Acute Phase ◽

Best Practice ◽

Evidence Base ◽

Post Stroke ◽

Effortful Swallow ◽

The Us ◽

Screening Assessment ◽

The Uk ◽

Management Of Dysphagia ◽

The Impact

The international approach to the assessment and management of dysphagia in the acute phase post stroke is little studied. A questionnaire was sent to clinicians in stroke services that explored the current practice in dysphagia screening, assessment, and management within the acute phase post stroke. The findings from four (the UK, the US, Canada, and Australia) of the 22 countries returning data are analysed. Consistent approaches to dysphagia screening and the modification of food and liquid were identified across all four countries. The timing of videofluoroscopy (VFS) assessment was significantly different, with the US utilising this assessment earlier post stroke. Compensatory and Postural techniques were employed significantly more by Canada and the US than the UK and Australia. Only food and fluid modification, tongue exercises, effortful swallow and chin down/tuck were employed by more than fifty percent of all respondents. The techniques used for assessment and management tended to be similar within, but not between, countries. Relationships were found between the use of instrumental assessment and the compensatory management techniques that were employed. The variation in practice that was found, may reflect the lack of an available robust evidence base to develop care pathways and identify the best practice. Further investigation and identification of the impact on dysphagia outcome is needed.

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Abstract P598: Increased Risk of Acute Stroke in Patients With Severe Course of Covid-19: A Multicenter Study and Meta-Analysis

Stroke ◽

10.1161/str.52.suppl_1.p598 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Timo Siepmann ◽

Annahita Sedghi ◽

Erik Simon ◽

Simon Winzer ◽

Jessica Barlinn ◽

...

Keyword(s):

Acute Stroke ◽

Multicenter Study ◽

Observational Studies ◽

Meta Analysis ◽

Clinical Severity ◽

Cochrane Library ◽

Stroke Rate ◽

Multicenter Cohort Study ◽

Increased Risk ◽

Study Heterogeneity

Introduction: Recent studies linked coronavirus disease 2019 (COVID-19) to thromboembolic complications likely mediated by increased blood coagulability and inflammatory endothelial impairment. Objective: We aimed to assess the risk of acute stroke in patients with COVID-19 related to clinical severity of the disease. Methods: We conducted an observational multicenter cohort study in four participating hospitals in Saxony, Germany to characterize consecutive patients with laboratory-confirmed COVID-19 who experienced acute stroke during hospitalization. Furthermore, we performed a systematic review using PubMed/MEDLINE, EMBASE, Cochrane Library and bibliographies of identified articles following PRISMA guidelines including data from observational studies of acute stroke in COVID-19 patients. Data was extracted by two independent reviewers and pooled with multicenter data to calculate risk ratios (RR) and 95% confidence intervals (95%CIs) for acute stroke related to COVID-19 severity using random effects model. Between-study heterogeneity was assessed using Cochran’s Q and I 2 -statistics. PROSPERO identifier : CRD42020187194. Results: Of 165 patients hospitalized for COVID-19 (49.1% males, median age 67 [57-79], 72.1% severe or critical) included in the multicenter study, overall stroke rate was 4.2% (95%CI: 1.9-8.7). Systematic literature search identified two observational studies involving 576 patients that were eligible for meta-analysis. Among 741 pooled COVID-19 patients overall stroke rate was 2.9% (95%CI: 1.9-4.5). Risk of acute stroke was increased for patients with severe compared to non-severe COVID-19 (RR 4.12, 95%CI 1.7-10.25; p=0.002) with no evidence of heterogeneity (I 2 =0%, p=0.82). Conclusions: Synthesized analysis of data from our multicenter study and previously published cohorts demonstrate that severity of COVID-19 is associated with an increased risk of acute stroke, underscoring the necessity of neurological monitoring in patients infected with SARS-CoV-2.

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Assessment of Risk Indicators for Targeted Cytomegalovirus Screening in Neonates

Neonatology ◽

10.1159/000512525 ◽

2020 ◽

pp. 1-6

Author(s):

Yael Levit ◽

Lianne Dym ◽

Sivan Yochpaz ◽

Yaara Manor ◽

Amos Adler ◽

...

Keyword(s):

Neonatal Screening ◽

Maternal Diabetes ◽

Comparative Data ◽

Risk Indicators ◽

Limited Information ◽

Cmv Infection ◽

Congenital Cytomegalovirus ◽

Increased Risk ◽

Targeted Screening ◽

Screening Protocol

Background: In the absence of universal screening for congenital cytomegalovirus (cCMV) infection, the aim of this study was to assess the outcomes of a targeted screening protocol based on maternal and neonatal risk indicators. Methods: The medical records of 2,623 neonates born in our maternal hospital between June 2016 and December 2018 and screened for cCMV infection were reviewed. Among those of the included neonates, the records of 380 CMV-negative and 19 CMV-positive neonates were randomly assigned to obtain additional comparative data. Results: During the study period, a total of 63 neonates were identified as positive for cCMV, comprising 0.2% of the total birth cohort (63/28,982) and 2.4% of all neonates screened for cCMV (63/2,623). The comparative data analysis showed that suspected or confirmed CMV infection during pregnancy, maternal age, and maternal diabetes mellitus were found to be significantly associated with a positive cCMV diagnosis. Although symmetric small for gestational age and hearing screening failure contributed to the detection of some of the CMV-positive infants, these factors were not specific to this group. The results of the logistic regression model showed that the only factor that was significantly associated with an increased risk for a cCMV diagnosis was maternal serology suspected of CMV infection during pregnancy, with a regression coefficient estimate of 2.657 (adjusted p < 0.001). Conclusions: A targeted neonatal screening protocol based on multiple maternal and neonatal risk indicators is feasible but provides limited information. Our study emphasizes the importance of universal neonatal screening for the detection of neonates with cCMV.

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Weekend effects of admission and surgery in acute aortic syndrome

10.22541/au.161012777.76373255/v1 ◽

2021 ◽

Author(s):

Chao Song ◽

YunLong Fan ◽

ShiXiong Wei ◽

Shengli Jiang

Keyword(s):

Primary Outcome ◽

Meta Analysis ◽

Mortality Rates ◽

Weekend Effect ◽

Acute Aortic Syndrome ◽

Random Effects Models ◽

Acute Aortic Syndromes ◽

Increased Risk ◽

Fixed And Random Effects ◽

All Cause Mortality

Background: The weekend effect is a phenomenon characterized by increased early all-cause mortality among patients hospitalized or undergoing surgery over the weekend for emergencies. Objectives: With this meta-analysis we aimed to determine whether weekend hospitalization/surgery due to acute aortic syndromes (AAS) is associated with increased early all-cause mortality. Methods：Major electronic databases were searched for studies published up to October 2020 reporting early all-cause mortality rates for admissions/operations on weekends versus weekdays. Data were pooled using fixed- and random-effects models. The primary outcome of the study was early all-cause mortality after weekend versus weekday. Results: All the included studies were retrospective, comparative or cohort studies enrolling patients admitted or underwent surgery for AAS and reported early all-cause mortality after weekend (including holiday) versus weekday. A total of 18 studies including a total of 252807 patients were identified. This meta-analysis showed a significant increase in the early all-cause mortality for patients admitted/conducted surgery for AAS on weekends compare with weekdays (fixed-effect: OR 1.1;95% CI 1.06-1.14;P＜0.00001). Conclusion: Weekend admission/surgery for AAS is associated with a increased risk of early all-cause mortality.

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Micro-Embolic Signals and Dissection: Association or Causation for Stroke? A Systematic Review and Meta-Analysis

Cerebrovascular Diseases ◽

10.1159/000519553 ◽

2021 ◽

pp. 1-8

Author(s):

Pachipala Sudheer ◽

Deepti Vibha

Keyword(s):

Systematic Review ◽

Acute Stroke ◽

Meta Analysis ◽

Small Population ◽

Cochrane Library ◽

Artery Dissection ◽

Cervical Artery Dissection ◽

Pooled Prevalence ◽

Increased Risk ◽

Embolic Signals

Background and Objective: Although the mechanism of stroke in cervical artery dissection (CAD) has been hypothesized to be embolization rather than hemodynamic compromise, there are a limited number of studies supporting this hypothesis. Detection of micro-embolic signals (MESs) using transcranial Doppler (TCD) helps in understanding the mechanism in these patients. A systematic review and meta-analysis were performed to estimate the prevalence of MES and its association with stroke outcomes in patients with acute stroke/TIA secondary to dissection. Methods: A comprehensive literature search was conducted for studies before January 26, 2021, in PubMed, Embase, Google Scholar, Cochrane Library, and ClinicalTrials.gov. Studies were identified that used TCD to detect MES in stroke/TIA patients secondary to CAD. Pooled prevalence was calculated. Entire statistical analysis was conducted in R version 3.6.2. Results: Eleven studies involving 112 patients (50 MES+, 62 MES−) were included in our meta-analysis. The pooled prevalence of MES among acute stroke/TIA patients secondary to dissection was 46.0% (95% CI 26.0–67.0%). The presence of MES was associated with an increased risk of early ischemic recurrence in patients with CAD. We could not estimate the functional outcome and mortality associated with the presence of MES due to the scarcity of data. Conclusions: Our meta-analysis showed 46% prevalence of MES in the studies which looked at acute stroke/TIA secondary to CAD using TCD. This finding supports the assumption that embolism may be a major cause of stroke in patients with dissection although this could be determined only in a small population.

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An Overview of Systematic Reviews and Meta-Analyses on Acupuncture for Post-Acute Stroke Dysphagia

Geriatrics ◽

10.3390/geriatrics4040068 ◽

2019 ◽

Vol 4 (4) ◽

pp. 68 ◽

Cited By ~ 1

Author(s):

Zi-Yu Tian ◽

Xing Liao ◽

Ying Gao ◽

Shi-Bing Liang ◽

Chong-Yang Zhang ◽

...

Keyword(s):

Acute Stroke ◽

Systematic Reviews ◽

Primary Outcome ◽

Acupuncture Treatment ◽

Meta Analysis ◽

Future Research ◽

Randomized Controlled ◽

Overview Of Systematic Reviews ◽

Meta Analyses

Background: Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Conflicting results from different SRs necessitated an overview to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this condition. The aim was to evaluate methodological quality and summarizing the evidence for important outcomes. Methods: Seven databases were searched for SRs and/or meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). Results: Searches yielded 382 SRs, 31 were included. The quality of 22 SRs was critically low, five SRs were low, and four Cochrane SRs were moderate when evaluated by AMSTAR2. A total of 17 SRs reported 85.2–96.3% of PRISMA items. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. Conclusion: Currently, evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is of a low quality. The type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research.

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