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The effects of endovascular clot retrieval and thrombolysis on dysphagia in an Australian quaternary hospital: A retrospective review.
- Source :
- International Journal of Language & Communication Disorders; Jan2022, Vol. 57 Issue 1, p128-137, 10p, 3 Charts, 1 Graph
- Publication Year :
- 2022
-
Abstract
- Dysphagia (impaired swallowing) is known to contribute to decreased quality of life, and increased length of hospital stay and mortality post‐stroke. Despite the advancements in stroke treatment with the introduction of thrombolysis and endovascular clot retrieval (ECR), patients continue to present with high rates of dysphagia. Speech and language therapists and stroke teams should consider the presence of haemorrhagic transformation, success of reperfusion and presence of communication deficits as risk factors for dysphagia post‐ECR and/or thrombolysis. Purpose: To establish incidence rates and patterns of dysphagia following the administration of reperfusion therapies in acute ischaemic stroke management. Method: A retrospective review of 193 patients admitted with acute ischaemic stroke to a quaternary stroke unit in Australia over a three year period was completed. Clinical information extracted included demographics, type (thrombolysis and/or endovascular clot retrieval) and success of reperfusion therapy, and the progression of dysphagia and related factors. Results: Over half of all patients treated with reperfusion therapies presented with dysphagia on initial assessment by speech‐language pathology (SLP). The type of reperfusion therapy administered was not significantly correlated with the presence of dysphagia. Dysphagia on initial assessment was significantly correlated with the presence of aphasia on initial assessment, the presence of haemorrhagic transformation, and the success of reperfusion. Increased rates of enteral feeding were also found in this study compared to figures reported in literature. Conclusion: This study identified ongoing high rates of dysphagia amongst this patient population regardless of treatment type, demonstrating the need for ongoing SLP management post stroke. Further research is required in this area to develop an evidence‐base for SLPs and the wider medical team and to inform clinical practice guidelines. What this paper adds: What is already known on the subject: Stroke is one of the leading causes of disability and death internationally. Dysphagia (impaired swallowing), a common sequalae of stroke, is known to contribute to decreased quality of life, increased length of hospital stay and mortality. With advancements in technology, treatments for acute ischaemic stroke (endovascular clot retrieval and thrombolysis) are increasing in popularity. However, limited research exists exploring the impact of these therapies on dysphagia. What this paper adds: Despite the advancements in stroke treatment, patients continue to present with high rates of dysphagia. Dysphagia following thrombolysis and/or ECR was found to be significantly correlated to the presence of aphasia, haemorrhagic transformation, and the success of reperfusion (regardless of treatment type). Additionally, increased rates of enteral feeding were found amongst this patient population compared to figures reported in the literature for patients following traditional stroke management. Clinical implications of this study: Speech‐language pathologists and the wider medical team should consider dysphagia as an ongoing consequence of stroke following reperfusion therapies, with consideration for success of reperfusion and adverse outcomes i.e., haemorrhagic transformation. Further research is required to provide an evidence‐base and specific guidelines for the management of dysphagia post reperfusion therapies, including use of enteral feeding. [ABSTRACT FROM AUTHOR]
- Subjects :
- DISEASE progression
SPEECH therapy
ACQUISITION of data methodology
ANALYSIS of variance
ISCHEMIC stroke
THROMBOLYTIC therapy
DEGLUTITION disorders
RETROSPECTIVE studies
DISEASE incidence
MAGNETIC resonance imaging
FISHER exact test
VEIN surgery
TREATMENT effectiveness
THROMBECTOMY
MEDICAL records
DESCRIPTIVE statistics
COMMUNICATION
RESEARCH funding
ENDOVASCULAR surgery
COMPUTED tomography
DATA analysis software
REPERFUSION
Subjects
Details
- Language :
- English
- ISSN :
- 13682822
- Volume :
- 57
- Issue :
- 1
- Database :
- Complementary Index
- Journal :
- International Journal of Language & Communication Disorders
- Publication Type :
- Academic Journal
- Accession number :
- 154715990
- Full Text :
- https://doi.org/10.1111/1460-6984.12681