Factors Associated with Risk of Stroke-Associated Pneumonia in Patients with Dysphagia: A Systematic Review.
Sabrina A Eltringham, Karen Kilner, Melanie Gee and 4 others
PMID 31493069WHAT IT FOUND
Prophylactic antibiotics did not reduce pneumonia risk.
Metoclopramide and multidisciplinary swallowing care appeared protective, but data were limited. PPI use was linked to higher risk. Nasogastric tube evidence was inconsistent. Mobility and dysphagia severity were strong risk markers.
Key findings
01Prophylactic antibiotics did not significantly reduce the incidence of stroke-associated pneumonia in patients with dysphagia.
02Metoclopramide use was associated with significantly fewer episodes of pneumonia compared to placebo in dysphagic patients.
03A multidisciplinary team approach to swallowing management was associated with reduced pneumonia incidence in two studies, though the specific components driving the effect were unclear.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
High heterogeneity in study designs, definitions of pneumonia, and timing of diagnosis prevented meta-analysis. Many included studies were observational or had methodological flaws, such as lack of blinding or unclear intervention components. The review excluded studies that did not report data specifically for dysphagia patients, potentially missing relevant evidence from larger trials. Variation in how dysphagia was assessed and defined across studies limits the generalizability of findings. The search was restricted to English-language publications, which may introduce language bias.
Declared interests
The study was funded by the Stroke Association. The authors declared no competing interests.
The easy way to misread this
Do not interpret the positive findings for metoclopramide or multidisciplinary care as definitive evidence of efficacy. The review highlights insufficient data to recommend specific interventions, and the apparent benefits may be influenced by study design flaws, heterogeneity, or unmeasured confounding factors.