Background and Aims Patients with dysphagia are at increased risk of stroke-associated pneumonia (SAP). There is wide variation in the way patients are screened and assessed. This systematic review addressed “How do methods of dysphagia assessment and management during the first 72 hours of admission affect the risk of SAP?” The objective was to identify which methods influence the risk of SAP in acute stroke. Methods Electronic databases (CINAHL, COCHRANE, EMBASE, MEDLINE and SCOPUS) were systematically searched for studies reporting dysphagia screening, or assessment, or management in acute stroke. The primary outcome was SAP. Eligible studies were critically appraised, data extracted and summarised. Heterogeneity was evaluated using random effects models. Results Twelve studies including data on 87824 patients were included. There was marked heterogeneity in study design between the included studies, which precluded meta-analysis. Nine studies were prospective observational studies. Two used a quasi-experimental design and 1 was a retrospective review. Type of dysphagia screening protocol varied widely. There was limited information on what comprised a specialist swallow assessment and alternative feeding was the only management strategy where data were analysed in relation to SAP. Use of a formal screening protocol, early dysphagia screening and assessment by a speech and language pathologist (SLP) was associated with a reduced risk of SAP. Conclusion There is variation in assessment and management of dysphagia in acute stroke. There is moderate evidence from observational studies only that early screening and specialist swallow assessment by a SLP may reduce the odds of SAP.
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