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Dysphagia and Associated Pneumonia in Stroke Patients from Brazil: A Systematic Review

Abstract

Dysphagia and its associated complications are expected to be relatively more frequent in stroke patients in Brazil than in similar patients treated in developed countries due to the suboptimal stroke care in many Brazilians medical services. However, there is no estimate of dysphagia and pneumonia incidence for the overall stroke population in Brazil. We conducted a systematic review of the recent literature to address this knowledge gap, first screening citations for relevance and then rating full articles of accepted citations. At both levels, judgements were made by two independent raters according to a priori criteria. Fourteen accepted articles underwent critical appraisal and data extraction. The frequency of dysphagia in stroke patients was high (59% to 76%). Few studies assessed pneumonia and only one study stratified patients by both dysphagia and pneumonia, with an increased Relative Risk for pneumonia in patients with stroke and dysphagia of 8.4 (95% CI 2.1, 34.4). Across all articles, we identified bias related to: heterogeneity in number and type of stroke; no rater blinding; and, assessments that were not reproducible, reliable or validated. Despite the high frequency of dysphagia and associated pneumonia in stroke patients in Brazil, the quality of the available literature is low and that there is little research focused on these epidemiologic data. Future rigorously designed studies are in dire need to accurately determine dysphagia incidence and its impact on stroke patients in Brazil. These data will be critical to properly allocate limited national resources that maximize the quality of stroke care.

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Acknowledgements

The authors would like to thank National Council of Scientific and Technological Development of Brazil (CNPq) and Coordination of Improvement of Higher Level Personnel (CAPES). Support from National Council of Scientific and Technological Development of Brazil (CNPq – 482721/2013-8 and 402388/2013-5) and Coordination of Improvement of Higher Level Personnel (CAPES).

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The authors participated sufficiently in the work to take public responsibility for appropriate portions of the content.

Correspondence to Aline Cristina Pacheco-Castilho.

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All studies included in this systematic review involving human subjects declared that they were performed after approval by the appropriate Research Ethics Committee and that the written informed consent was obtained from all participants.

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Pacheco-Castilho, A.C., Vanin, G.M., Dantas, R.O. et al. Dysphagia and Associated Pneumonia in Stroke Patients from Brazil: A Systematic Review. Dysphagia 34, 499–520 (2019). https://doi.org/10.1007/s00455-019-10021-0

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Keywords

  • Deglutition
  • Deglutition disorders
  • Dysphagia
  • Pneumonia
  • Stroke
  • Brazil