A RANDOMIZED TRIAL OF A NURSE-LED BEDSIDE SWALLOW SCREENING PROTOCOL ON POST-STROKE PNEUMONIA RATES.

Abstract

Background: Post-stroke pneumonia remains a leading cause of early morbidity in acute stroke patients, often resulting from unrecognized dysphagia. Timely swallow screening plays a crucial role in preventing aspiration and guiding safe feeding decisions. Nurse-led protocols offer a practical approach to early detection but require further evaluation through controlled trials.

Objective: To assess the effectiveness of a nurse-led bedside swallow screening protocol in reducing post-stroke pneumonia and improving early dysphagia management.

Methods: A randomized controlled trial was conducted involving 300 acute stroke patients allocated equally to an intervention group receiving a structured nurse-led bedside swallow screening protocol and a control group receiving standard care. Outcomes included time to swallow screening, initial screening failure rates, aspiration events, early oral feeding initiation, and post-stroke pneumonia incidence within seven days. All participants were followed prospectively, and data were analyzed using intention-to-treat principles.

Results: The intervention group received swallow screening considerably earlier than controls, with a mean time of 21.6 minutes compared to 58.2 minutes. Initial screening failure occurred less frequently in the intervention group (31.3%) than in the control group (59.3%). Aspiration-confirmed events were reduced by more than half in the intervention group, and early oral feeding within 24 hours was achieved by 55.3% compared to 34.0% in the control group. Most notably, post-stroke pneumonia occurred in 9.3% of the intervention group, substantially lower than the 22.0% observed in the control group, indicating a clear benefit of structured nurse-led assessment.

Conclusion: The nurse-led bedside swallow screening protocol proved effective in promoting earlier dysphagia detection, reducing aspiration events, and significantly lowering post-stroke pneumonia rates. These findings support its integration into routine stroke management as a feasible and impactful strategy to enhance early patient outcomes.