Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke

Oliveira, Ana Railka de Souza; Costa, Alice Gabrielle de Sousa; Morais, Huana Carolina Cândido; Cavalcante, Tahissa Frota; Lopes, Marcos Venícios de Oliveira; Araujo, Thelma Leite de

doi:10.1590/0104-1169.0197.2545

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 23 (2) • Feb-Apr 2015 • https://doi.org/10.1590/0104-1169.0197.2545 copy

Clinical factors predicting risk for aspiration and respiratory aspiration among patients with Stroke¹ 1 Paper extracted from doctoral dissertation "Validation of the nursing outcomes state of swallowing and prevention of aspiration in patients with stroke", presented to Universidade Federal do Ceará, Fortaleza, CE, Brazil. Supported by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil, process # 475490/2012-6.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to investigate the association of risk factors with the Risk for aspiration nursing diagnosis and respiratory aspiration.

Method:

cross-sectional study assessing 105 patients with stroke. The instrument used to collect data addressing sociodemographic information, clinical variables and risk factors for Risk for aspiration. The clinical judgments of three expert RNs were used to establish the diagnosis. The relationship between variables and strength of association using Odds Ratio (OR) was verified both in regard to Risk for aspiration and respiratory aspiration.

Results:

risk for aspiration was present in 34.3% of the patients and aspiration in 30.5%. The following stood out among the risk factors: Dysphagia, Impaired or absent gag reflex, Neurological disorders, and Impaired physical mobility, all of which were statistically associated with Risk for aspiration. Note that patients who develop such a diagnosis were seven times more likely to develop respiratory aspiration.

Conclusion:

dysphagia, Impaired or absent gag reflex were the best predictors both for Risk for aspiration and respiratory aspiration.

Nursing; Nursing Diagnosis; Respiratory Aspiration; Stroke; Nursing Assessment

Risk factors		N	%
Impaired or decreased gag reflex		34	32.4
Impaired or absent cough reflex		30	28.6
Dysphagia		25	23.8
Neurological disorders		23	21.9
Impaired physical mobility		23	21.9
Low headboard		14	13.3
Use of gastrointestinal tubes		3	2.9
	Nursing diagnosis
Risk for aspiration		36	34.3
Respiratory aspiration		32	30.5

Variable		Risk for aspiration		Total	p*	OR^†	IC 95%^‡
		Present	Absent
Dysphagia					˂0.002	4.214	1.642-10.815
	Present	15	10	25
	Absent	21	59	80
	Total	36	69	105
Impaired or absent cough reflex					0.560	0.762	0.306-1.897
	Present	9	21	30
	Absent	27	48	75
	Total	36	69	105
Neurological disorders					0.004	0.134	0.030-0.612
	Present	2	21	23
	Absent	34	48	82
	Total	36	69	105
Use of gastrointestinal tubes					˂0.972	0.957	0.084-10.927
	Present	1	2	3
	Absent	35	67	102
	Total	36	69	105
Impaired physical mobility					0.042	2.636	1.023-6.792
	Present	12	11	23
	Absent	24	58	82
	Total	36	69	105
Impaired or absent gag reflex					0.001	19.825	7.029-55.913
	Present	26	8	34
	Absent	10	61	71
	Total	36	69	105
Low headboard					0.630	0.738	0.214-2.540
	Present	4	10	14
	Absent	32	59	91
	Total	36	69	105

Variables		Respiratory aspiration		Total	p*	OR^†	IC 95%^‡
		Present	Absent
Dysphagia					<0.001	12.122	4.258-34.515
	Present	18	7	25
	Absent	14	66	80
	Total	32	73	105
Impaired or absent cough reflex					0.689	1.205	0.486-2.985
	Present	10	20	30
	Absent	22	53	75
	Total	32	73	105
Neurological disorders					0.996	0.998	0.365-2.725
	Present	7	16	23
	Absent	25	57	82
	Total	32	73	105
Use of gastrointestinal tubes					0.169	4.800	0.419-54.958
	Present	2	1	3
	Absent	30	72	102
	Total	32	73	105
Impaired physical mobility					<0.042	2.262	1.023-6.931
	Present	11	12	23
	Absent	21	61	82
	Total	32	73	105
Impaired or absent gag reflex					<0.001	11.183	4.237-29.516
	Present	22	12	34
	Absent	10	61	71
	Total	32	73	105
Low headboard					<0.649	1.317	0.404-4.295
	Present	5	9	14
	Absent	27	64	91
	Total	32	73	105
Risk for respiratory aspiration diagnosis					<0.001	7.381	2.928-18.604
	Present	21	15	36
	Absent	11	58	69
	Total	32	73	105

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Ana Railka de Souza Oliveira Universidade Estadual de Campinas. Faculdade de Enfermagem Rua Tessália Vieira de Camargo, 126 Cidade Universitária Zeferino Vaz CEP 13083-887 - Campinas, SP, Brasil E-mail: ana.railka@gmail.com