CLINICAL IMPLICATIONS OF LIMITING ORAL INTAKE OF THIN LIQUIDS AFTER ACUTE STROKE

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 \u3e1 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\u3e11 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\u3e11 days (2.5-fold); age\u3e60 (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