Evidence Based

2

Intervention PICOT

Student's Name

Institutional Affiliation

Professor’s Name

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Due Date

PICOT Question: In adult stroke patients, what is the effect of assessing a patient with dysphagia screening after imaging results with two nurses 30 minutes apart, with reassessment every 24 hours for three days, on stroke-associated pneumonia compared to usual care according to the American Heart Association?

Patient group of Interest: Adult stroke patients are the patient group in whom I'm most interested. A stroke is a serious medical emergency that may have a significant impact on a person's life and cause long-term physical and mental problems (Centers for Disease Control and Prevention, 2022). In the United States, 1 in 6 persons will have a stroke, and many may suffer long-term consequences and disability (Centers for Disease Control and Prevention, 2022). Elderly people and African Americans are the two groups most often affected by stroke (Centers for Disease Control and Prevention, 2022).

Intervention/Issue: The intervention that interests me involves screening for dysphagia in a patient following imaging findings with two nurses, 30 minutes apart, and then reevaluating the patient every day for three days. Dysphagia, or trouble swallowing, is a disorder that affects a lot of stroke victims, particularly those who have paralysis and/or aphasia. Dysphagia increases the risk of death and may cause aspiration pneumonia (Lo et al., 2019).

Comparison Intervention: The intervention I will contrast with is standard treatment, in accordance with the American Heart Association's recommendation that dysphagia screening be carried out within 24 hours following a stroke, regardless of imaging results, and that additional multidisciplinary team members may do an assessment (Bosch et al., 2022). This is the standard procedure for diagnosing dysphagia in stroke patients, and it works well to stop aspiration pneumonia and diagnose dysphagia.

Outcomes: I would like to see a decrease in post-stroke pneumonia, which is a common complication from strokes and is linked to a higher risk for mortality (Grossmann et al., 2021). Post-stroke pneumonia affects about 10% of patients, despite the use of protocols in a thoroughly researched field. I would want to see a rise in the proportion of stroke patients who are recognized as having dysphagia as well as an improvement in the efficacy of dysphagia screening.

Time: It is hard to say exactly when, but I believe I would want to do it within a week of receiving a stroke diagnosis since pneumonia takes a few days to manifest and some stroke patients see a worsening of symptoms within a week. According to one of the studies, pneumonia occurs in 2.3–44% of patients within seven days, and in 43–79% of patients within 72 hours of the stroke's beginning (Shin et al., 2023). I believe that this period of time would be ideal for evaluating the intervention's results.

My PICOT question is, " In adult stroke patients, what is the effect of assessing a patient with dysphagia screening after imaging results with two nurses 30 minutes apart, with reassessment every 24 hours for three days, on stroke-associated pneumonia compared to usual care according to the American Heart Association?" With the use of this query, dysphagia screening will be more accurate and post-stroke pneumonia will occur less often in adult stroke patients.

References

Bosch, G., Comas, M., Domingo, L., Guillen‐Sola, A., Duarte, E., Castells, X., & Sala, M. (2022). Dysphagia in hospitalized patients: Prevalence, related factors and impact on aspiration pneumonia and mortality. European Journal of Clinical Investigation, 53(4). https://doi.org/10.1111/eci.13930

Centers for Disease Control and Prevention. (2022, May 4). Stroke Signs and Symptoms. Centers for Disease Control and Prevention. https://www.cdc.gov/stroke/signs_symptoms.htm

Grossmann, I., Rodriguez, K., Soni, M., Joshi, P. K., Patel, S. C., Shreya, D., Zamora, D. I., Patel, G. S., & Sange, I. (2021). Stroke and Pneumonia: Mechanisms, Risk Factors, Management, and Prevention. Cureus, 13(11), e19912. https://doi.org/10.7759/cureus.19912

Lo, W.-L., Leu, H.-B., Yang, M.-C., Wang, D.-H., & Hsu, M.-L. (2019). Dysphagia and risk of aspiration pneumonia: A nonrandomized, pair-matched cohort study. Journal of Dental Sciences, 14(3), 241–247. https://doi.org/10.1016/j.jds.2019.01.005

Shin, D., Lebovic, G., & Lin, R. J. (2023). In-hospital mortality for aspiration pneumonia in a tertiary teaching hospital: A retrospective cohort review from 2008 to 2018. Journal of Otolaryngology - Head & Neck Surgery, 52(1). https://doi.org/10.1186/s40463-022-00617-2