DOI
https://doi.org/10.25772/CBG9-2X69
Author ORCID Identifier
0000-0001-7937-5304
Defense Date
2025
Document Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Health Related Sciences
First Advisor
Stacey Reynolds
Abstract
Background and Aims
Although thickened liquids are often recommended for post-stroke dysphagia in order to limit aspiration and its sequelae, it is unclear if they achieve this goal. This dissertation explored relationships between dysphagia, liquid restrictions, and outcomes of aspiration pneumonia and urinary tract infection (UTI) during acute-care hospitalization for stroke.
Methods
We reviewed charts for 1216 individuals admitted with stroke to an acute-care hospital (December 2021-August 2024). Logistic regression analyses were used to examine relationships between stroke type/location/lateralization/severity, length-of-stay (LOS), age, sex-assigned-at-birth, dysphagia, smoking, dentition, liquid intake restrictions >1 day, and outcomes of aspiration pneumonia and UTI.
Results
Aspiration pneumonia and UTI incidence were 114 (9.8%) and 122 (10%), respectively. Dysphagia was documented in 385 (32%) of the 1,216 sample. Instrumental swallowing assessments were performed in only 214 (18%) cases. Thickened liquids were recommended for 43 (3.5%) and NPO for 286 (23.5%). In 96/329 (29%) of the cases where liquid restrictions were ordered there was no dysphagia diagnosis present. Significantly increased odds of aspiration pneumonia were associated with: LOS>11 days (4.5-fold); female sex (1.95-fold); thickened liquids (11-fold) and nothing by mouth (27.6-fold), independent of dysphagia diagnosis. Significantly increased odds of UTI were associated with: LOS>11 days (2.5-fold); age>60 (1.96-fold); female sex (0.39-fold); and NPO recommendation (2-fold).
Conclusions
In this acute stroke cohort, dysphagia, by itself, did not significantly predict aspiration pneumonia or UTI. NPO recommendations were highly associated with increased odds of both adverse outcomes, while thickened liquids were associated with increased odds of aspiration pneumonia. The early diagnosis of aspiration pneumonia and UTI during the hospital course suggests that factors unrelated to liquid intake restriction may explain these sequelae.
Rights
© Megan E Crawford
Is Part Of
VCU University Archives
Is Part Of
VCU Theses and Dissertations
Date of Submission
4-15-2025
Included in
Nephrology Commons, Neurology Commons, Neurosciences Commons, Neurosurgery Commons, Pulmonology Commons, Speech Pathology and Audiology Commons