| Title |
Implementing Cough Reflex Testing in a Clinical Pathway for Acute Stroke: A Pragmatic Randomised Controlled Trial
|
|---|---|
| Published in |
Dysphagia, May 2018
|
| DOI | 10.1007/s00455-018-9908-5 |
| Pubmed ID | |
| Authors |
Makaela Field, Rachel Wenke, Arman Sabet, Melissa Lawrie, Elizabeth Cardell |
| Abstract |
Silent aspiration is common after stroke and can lead to subsequent pneumonia. While standard bedside dysphagia assessments are ineffective at predicting silent aspiration, cough reflex testing (CRT) has shown promise for identifying patients at risk of silent aspiration. We investigated the impact of CRT on patient and service outcomes when embedded into a clinical pathway. 488 acute stoke patients were randomly allocated to receive either CRT or standard care (i.e. bedside assessment). Primary outcomes included confirmed pneumonia within 3 months post stroke and length of acute inpatient stay. Secondary outcomes related to the feasibility of implementing a CRT pathway and clinician and patient satisfaction. There was a non-significant reduction in pneumonia rates by 2.2% points in the CRT group (OR 0.32, 95% CI 0.06-1.62). There was a non-significant difference of 0.7 days (95% CI - 0.29 to 1.71 days) in length of stay between the standard care group and the CRT group. The CRT took on average 3 min longer to complete (p < 0.01) and resulted in a significant 6.7% increase in videofluoroscopic referrals (p = 0.02); however, these results are clinically insignificant. High patient and clinician satisfaction with CRT was found, with clinicians reporting additional knowledge and confidence in decision making for dysphagia management. Post hoc subgroup analyses according to stroke types were conducted and revealed no significant differences in pneumonia rates after adjustment for multiple comparisons. In conclusion, it was possible to implement a CRT pathway with minimal increases in clinician resources. While clinicians perceived CRT as beneficial in clinical decision making, the efficacy of CRT for reducing pneumonia rates in acute stroke remains to be established.Clinical Trial Registration-URL: http://www.anzctr.org.au . Unique identifier: ACTRN12616000724471. |
X Demographics
The data shown below were collected from the profiles of 27 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 10 | 37% |
| Australia | 3 | 11% |
| United States | 3 | 11% |
| Ireland | 2 | 7% |
| Spain | 1 | 4% |
| Austria | 1 | 4% |
| Canada | 1 | 4% |
| Unknown | 6 | 22% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 17 | 63% |
| Scientists | 6 | 22% |
| Practitioners (doctors, other healthcare professionals) | 4 | 15% |
Mendeley readers
The data shown below were compiled from readership statistics for 111 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 111 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 16 | 14% |
| Researcher | 11 | 10% |
| Student > Ph. D. Student | 11 | 10% |
| Student > Bachelor | 10 | 9% |
| Other | 8 | 7% |
| Other | 20 | 18% |
| Unknown | 35 | 32% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 29 | 26% |
| Nursing and Health Professions | 21 | 19% |
| Neuroscience | 5 | 5% |
| Psychology | 3 | 3% |
| Engineering | 2 | 2% |
| Other | 8 | 7% |
| Unknown | 43 | 39% |
Attention Score in Context
This research output has an Altmetric Attention Score of 19. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 15 August 2019.
All research outputs
#1,887,991
of 24,976,442 outputs
Outputs from Dysphagia
#88
of 1,360 outputs
Outputs of similar age
#39,481
of 333,403 outputs
Outputs of similar age from Dysphagia
#6
of 26 outputs
Altmetric has tracked 24,976,442 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 92nd percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,360 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.9. This one has done particularly well, scoring higher than 93% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 333,403 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 88% of its contemporaries.
We're also able to compare this research output to 26 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 80% of its contemporaries.