Abstract P51: Aspiration Pneumonia is a Negative Predictor of Post-Stroke Level of Care: Findings From the UTHSC Houston Stroke Registry

Abstract

Introduction: Aspiration Pneumonia (AsPNA) in acute stroke patients can lead to a three-fold risk in mortality. Treatment of AsPNA requires increased acuity of hospital care for antibiotic therapy and respiratory management. This care is provided at all levels, including Inpatient Rehabilitation (IR), Skilled Nursing Facility (SNF) or Sub-acute Care (Sub). There are limited studies assessing the role of AsPNA as an independent predictor of post-stroke disposition. Hypothesis: Low NIHSS is a predictor of higher functional status. We assessed the hypothesis that absence of AsPNA predicts post-stroke disposition to a functional level similar to low NIHSS. Methods: All patients admitted to the UT Stroke Service between January 2004 and October 2009 were included. Stratification occurred for age>65, NIHSS and stroke risk factors. Using multivariate logistic regression, the data was analyzed for differences in post-stroke disposition among patients without aspiration pneumonia. Results: Home vs. Other Level of Care Of 3390 patients, 1668 were discharged home, 1722 to another level of care. Patients without AsPNA are 5.3 times more likely to be discharged home (P = <.0001, OR 5.272, 95% CI 2.902 to 9.578). Patients with NIHSS < 8 are 15.1 times more likely to be discharged home. IR vs. SNF Of 1547 patients, 983 patients were discharged to IR, 564 to SNF. Patients without AsPNA are 8.6 times more likely to be discharged to IR (P = <.0001, OR 8.592, 95% CI 4.574 to 16.140). Patients with NIHSS < 8 are 3.4 times more likely to be discharged to IR. SNF vs. Sub Of 739 patients, 564 were discharged to SNF, 175 to Sub. Patients without AsPNA are 5.5 times more likely to be discharged to SNF (P = <.0001, OR 5.461, 95% CI 3.571 to 8.351). Patients with NIHSS < 8 are 2.6 times more likely to be discharged to SNF. Conclusions: The absence of AsPNA is an independent predictor of improved post-stroke disposition. Patients with AsPNA have an increased likelihood of post-acute stroke care at a lower functional level, with a correlation stronger than NIHSS. This study is limited by its retrospective nature and unmeasured psychosocial factors related to discharge. Prospective studies on dysphagia screening, dietary modification and respiratory management are needed.