RESUMO
BACKGROUND/OBJECTIVES: Early swallow screening, within 4 h of admission, is required for all acute stroke patients to commence nutritional support, as recommended. We evaluated the impact of delay in early swallow screening on outcomes in patients admitted with acute stroke. SUBJECTS/METHODS: Prospective cohort study of 1656 men (mean ± SD age = 73.1y ± 13.2) and 1653 women (79.3y ± 13.0) admitted with stroke to hyperacute stroke units (HASUs) in Surrey. Logistic regression was used to assess the risk (adjusted for age, stroke severity and co-morbidities) of delay in swallow screening on pneumonia, length of stay (LOS) > 3 weeks in HASU or hospital, moderately severe to severe disability on discharge (modified Rankin scale score = 4-5) and mortality during admission. RESULTS: Compared with those who received swallow screening within 4 h of admission, a delay between 4 and 72 h was associated with greater risks of pneumonia: OR = 1.4 (95%CI:1.1-1.9, P = 0.022), moderately severe to severe disability on discharge: OR = 1.4 (1.1-1.7, P = 0.007) and a delay beyond 72 h was associated with even greater risks of pneumonia: OR = 2.3 (1.4-3.6, P < 0.001), prolonged LOS in HASU: OR = 1.7 (1.0-3.0, P = 0.047, median LOS = 6.2 vs. 14.7 days) and hospital: OR = 2.1-fold (1.3-3.4, P = 0.007, median LOS = 6.8 vs. 14.9 days), moderately severe to severe disability on discharge: OR = 2.5 (1.7-3.7, P < 0.001) and mortality: OR = 3.8 (2.5-5.6, P < 0.001). These risks persisted after excluding 103 patients who died within 72 h. CONCLUSIONS: Delay in early screening for swallow capacity in acute stroke patients is detrimental to outcomes, possibly due to delaying nutritional provision or through inappropriate feeding leading to aspiration. Routine early screening needs greater attention in HASUs.
Assuntos
Transtornos de Deglutição/complicações , Pessoas com Deficiência , Tempo de Internação , Alta do Paciente , Pneumonia/etiologia , Acidente Vascular Cerebral/complicações , Idoso , Idoso de 80 Anos ou mais , Transtornos de Deglutição/diagnóstico , Diagnóstico Tardio , Feminino , Hospitalização , Hospitais , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Apoio Nutricional , Razão de Chances , Pneumonia Aspirativa/etiologia , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/mortalidadeAssuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/farmacologia , Fibrilação Atrial/terapia , Cardioversão Elétrica , Mediadores da Inflamação/sangue , Fibrilação Atrial/sangue , Fibrilação Atrial/fisiopatologia , Benzimidazóis/farmacologia , Compostos de Bifenilo , Proteína C-Reativa/efeitos dos fármacos , Proteína C-Reativa/metabolismo , Ligante de CD40/sangue , Ligante de CD40/efeitos dos fármacos , Selectina E/sangue , Selectina E/efeitos dos fármacos , Sistema de Condução Cardíaco/efeitos dos fármacos , Sistema de Condução Cardíaco/metabolismo , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Interleucina-6/sangue , Selectina-P/sangue , Selectina-P/efeitos dos fármacos , Tetrazóis/farmacologia , Fator de Necrose Tumoral alfa/sangue , Fator de Necrose Tumoral alfa/efeitos dos fármacos , Molécula 1 de Adesão de Célula Vascular/sangue , Molécula 1 de Adesão de Célula Vascular/efeitos dos fármacosRESUMO
Bayer AG and Ortho-McNeil Pharmaceutical Inc are developing rivaroxaban, an oral Factor Xa inhibitor, for the potential prevention and treatment of thrombosis. In December 2005 and December 2006, phase III trials were initiated for the prevention of venous thromboembolism (VTE) following major orthopedic surgery and in patients with atrial fibrillation, respectively. By January 2007, a phase III trial for the prevention of VTE following total knee replacement surgery had commenced. In November 2006, a phase II trial for the reduction of VTE in patients with acute coronary syndrome was initiated.