- Design
- Single-centre retrospective cohort
- Population
- 12,374 adults admitted to general wards
- Primary outcome
- Hospital-acquired aspiration pneumonia
- Effect
- 0.8% vs 2.1%; adjusted RR 0.42 (0.27–0.66)
A Japanese hospital introduced a nurse-led dysphagia screen for every general ward admission: the EAT-10 questionnaire, then a repetitive saliva swallow test and observation at a meal where needed. Investigators compared 10,947 patients screened according to the protocol with 1,427 who were not, over one year.
Hospital-acquired aspiration pneumonia, confirmed on chart review, occurred in 0.8% of screened patients against 2.1% of the rest. After adjusting for age, comorbidity, procedures and other factors, protocol adherence was associated with a risk ratio of 0.42 (95% CI 0.27–0.66). Stroke, dementia and respiratory disease carried the highest risk.
This is a single-centre observational comparison, and patients who were not screened may have differed in ways the adjustment missed. But the intervention is cheap, nurse-delivered and low risk, and aspiration pneumonia is a common cause of avoidable harm on medical wards.
- Consider a simple nurse-led swallow screen for every adult admitted to a general medical ward.
- Prioritise screening in patients with stroke, dementia or chronic respiratory disease.
- Keep patients who fail the screen nil by mouth or on modified diet until assessed.
- Reassess swallowing after sedation, delirium or a change in conscious level.
Why it matters
Aspiration pneumonia on the ward is treated as bad luck when it may be partly preventable at the door.
Don't overread it
This was observational and single-centre; unscreened patients may have been sicker or admitted out of hours.
The statistics, in plain English
An RR of 0.42 means less than half the risk among screened patients. The interval 0.27–0.66 is well below 1, but this compares people who were and were not screened, not randomised groups.
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