1. Management of swallowing in thrombolysed stroke patients:
Logan Hospital/Speech Pathology Department
Management of swallowing in thrombolysed stroke patients:
Implementation of a new protocol
Maria Schwarz (1, 2), Anne Coccetti (1), Elizabeth Cardell (3), Allison Murdoch (1), Jennifer Davis (1)
(1) Logan Hospital, Metro South Hospital and Health Service, (2) University of Queensland- School of Health and Rehabilitation Sciences (3) Griffith University- Menzies Health Institute
Results to be published in the International Journal of Speech Language Pathology

2. Stroke – The impact of dysphagia
Stroke is a common cause of death and disability (1)
Dysphagia following stroke is common (2).
Dysphagia can result in (3, 4, 5, 6):
Aspiration
Dehydration
Malnutrition
Pneumonia
Early detection and management reduces complications and costs of dysphagia (7,8,9)

3. Stroke- New treatment options
Thrombolysis is increasingly being used as a treatment for ischemic stroke (10,11)
Post thrombolysis strict guidelines exist outlining the care of a thrombolysed patient (12)

4. Post thrombolysis dysphagia management
Literature search showed limited evidence regarding post thrombolysis dysphagia management (13)
The “Logan Hospital Speech Pathology Dysphagia Management in Thrombolysed Stroke Patient” clinical pathway was therefore developed and implemented (13)

6. Aims
To investigate the impact of a dysphagia management protocol on the outcomes of thrombolysed stroke patients

7. Method Retrospective case control study
83 stroke patients were identified for inclusion
43 Non thrombolysed ischemic stroke patients
40 Thrombolysed patients
12 pre protocol implementation
28 post protocol implementation
Inclusion Criteria
Exclusion Criteria
Adult patient (over 18)
Children
Diagnosis of ischemic stroke (documented by admitting medical team)
Diagnosis of transient ischemic attack (TIA) or haemorrhagic stroke.
Discharged or transferred to an alternative facility or made palliative immediately after admission.

8. Patient Demographics Sex (male) 37 (44.6%) 7 (58.3%) 13 (46.4%)
All Patients (n=83)
Pre protocol thrombolysed group (n=12)
Post protocol thrombolysed group (n=28)
Non thrombolysed group (n=43)
Sex (male)
37 (44.6%)
7 (58.3%)
13 (46.4%)
17 (39.5%)
Mean age at time of stroke
69.9
65.58
68.21
71.27
Initial stroke
65 (78.3%)
12 (100%)
26 (92.9%)
27 (62.8%)
Presence of stroke risk factors (present)
70 (84.3%)
10 (83.3%)
22 (78.6%)
38 (88.4%)

9. Data collected

10. Results- How long did patients remain NBM?

11. Results- Weekend variation

12. Results- What happened to patient complications?

13. Results- What were the benefits for the hospital?

14. Discussion and Conclusion
Overall results suggest some positive and potentially important clinical findings from the implementation of clinical protocol in thrombolysed patient dysphagia management.
Lack of speech pathology services on weekends impacted negatively on patients commencing oral intake.
Compliance is improved significantly with the implementation of a formalised management protocol

15. References
Gandolfi, Marialuisa, Smania, Nicola, Bisoffi, Giulia, Squaquara, Teresa, Zuccher, Paola, & Mazzucco, Sara. (2014). Improving post-stroke dysphagia outcomes through a standardized and multidisciplinary protocol: An exploratory cohort study. Dysphagia, 29(6),
(2010). Clinical Guideliens for Stroke Management. National Stroke Foundation.
Chouinard, Jean, Lavigne, Erika, & Villeneuve, Carole. (1998). Weight loss, dysphagia, and outcome in advanced dementia. Dysphagia, 13(3),
Foley, Norine C, Martin, Ruth E, Salter, Katherine L, & Teasell, Robert W. (2009). A review of the relationship between dysphagia and malnutrition following stroke. Journal of Rehabilitation Medicine, 41(9),
Hinds, NP, & Wiles, CM. (1998). Assessment of swallowing and referral to speech and language therapists in acute stroke. QJM, 91(12),
Low, Janet, Wyles, Christine, Wilkinson, Tim, & Sainsbury, Richard. (2001). The effect of compliance on clinical outcomes for patients with dysphagia on videofluoroscopy. Dysphagia, 16(2),
Perry, Lin, & Love, Claire P. (2001). Screening for dysphagia and aspiration in acute stroke: a systematic review. Dysphagia, 16(1), 7-18.
Smithard, DG, O'neill, PA, Park, CL, Morris, J, Wyatt, R, England, R, & Martin, DF. (1996). Complications and outcome after acute stroke does dysphagia matter? Stroke, 27(7),
Martino, Rosemary, Pron, Gaylene, & Diamant, Nicholas. (2000). Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines. Dysphagia, 15(1),
Wardlaw, Joanna M, Koumellis, Panos, & Liu, Ming. (2013). Thrombolysis (different doses, routes of administration and agents) for acute ischaemic stroke. The Cochrane Library.
Wardlaw, Joanna M, Murray, Veronica, Berge, Eivind, del Zoppo, Gregory, Sandercock, Peter, Lindley, Richard L, & Cohen, Geoff. (2012). Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. The Lancet, 379(9834),
DeMers, Gerard, Meurer, William J, Shih, Richard, Rosenbaum, Steve, & Vilke, Gary M. (2012). Tissue plasminogen activator and stroke: review of the literature for the clinician. The Journal of emergency medicine, 43(6),
Davis, Jennifer, Cardell, Elizabeth, & Coccetti, Anne. (2014). Management of dysphagia in thrombolysed stroke patients: Development of a preliminary clinical practice protocol. Journal of Clinical Practice Speech Language Pathology, 16(2),

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