Article Figures & Data
- Figure 1
Patient flow chart. CSCA, Chinese Stroke Center Alliance.
- Table 1
Baseline characteristics of patients with and without DS
Variables Total, n (%)
N=790 811Documented DS, n (%)
N=622 718 (78.7%)No documented DS, n (%)
N=168 093 (21.3%)ASD Age, mean (SE) 66.2 (12.0) 66.2 (12.0) 65.8 (11.9) 3.3 Male 494 756 (62.6) 390 000 (62.6) 104 756 (62.3) 0.6 Arrival by EMS 82 859 (10.5) 66 569 (10.7) 16 290 (9.7) 3.3 Admission NIHSS score, median (IQR)* 3.0 (2.0–6.0) 3.0 (2.0–6.0) 3.0 (2.0–6.0) 5.7 0–3 347 950 (44.0) 290 681 (46.7) 57 269 (34.1) 25.9 4–14 251 270 (31.8) 211 311 (33.9) 39 959 (23.8) 22.4 ≥15 34 051 (4.3) 27 072 (4.3) 6979 (4.2) 0.5 Hospitalised in SUs 193 968 (24.5) 162 518 (26.1) 31 450 (18.7) 17.8 Medical history Stroke/TIA 263 769 (33.4) 203 928 (32.7) 59 841 (35.6) 6.1 Hypertension 509 975 (64.5) 405 731 (65.2) 104 244 (62.0) 6.7 Diabetes mellitus 170 334 (21.5) 136 209 (21.9) 34 125 (20.3) 3.9 Dyslipidaemia 61 111 (7.7) 47 051 (7.6) 14 060 (8.4) 2.9 CHD/previous MI 69 357 (8.8) 55 383 (8.9) 13 974 (8.3) 2.1 Atrial fibrillation 39 276 (5.0) 31 983 (5.1) 7293 (4.3) 3.8 Carotid stenosis 10 288 (1.3) 8152 (1.3) 2136 (1.3) <0.01 PVD 13 775 (1.7) 10 760 (1.7) 3015 (1.8) 0.8 Heart failure 7884 (1.0) 6351 (1.0) 1533 (0.9) 1.0 Dementia 3743 (0.5) 3096 (0.5) 647 (0.4) 1.5 Smoking 293 172 (37.1) 232 940 (37.4) 60 232 (35.8) 3.3 Alcoholism 185 420 (23.4) 147 324 (23.7) 38 096 (22.7) 2.4 Region Eastern 367 586 (46.5) 294 309 (47.3) 73 277 (43.6) 7.4 Central 258 162 (32.6) 194 643 (31.3) 63 519 (37.8) 13.7 Western 165 063 (20.9) 133 766 (21.5) 31 297 (18.6) 7.2 Hospital grade Secondary 307 090 (38.8) 239 975 (38.5) 67 115 (39.9) 2.9 Tertiary 483 721 (61.2) 382 743 (61.5) 100 978 (60.1) 2.9 *The NIHSS score was missing for 157 540 (19.9%) patients.
.ASDs, absolute standardised differences; CHD, coronary heart disease; DS, dysphagia screening; EMS, emergency medical services; MI, myocardial infarction; NIHSS, National Institute of Health Stroke Scale; PVD, peripheral vascular disease; SUs, stroke units; TIA, transient ischaemic attack.
- Table 2
Multivariable models of factors associated with documentation of DS
Variable Patients with and without NIHSS scores, N=790 811 Patients with NIHSS scores, N=633 271 OR (95% CI) P value OR (95% CI) P value Hospitalised in SUs 1.50 (1.48 to 1.52) <0.0001 1.38 (1.36 to 1.40) <0.0001 Medical history Stroke/TIA 0.87 (0.86 to 0.88) <0.0001 0.89 (0.88 to 0.91) <0.0001 Hypertension 1.16 (1.14 to 1.17) <0.0001 1.13 (1.11 to 1.14) <0.0001 Diabetes mellitus 1.10 (1.08 to 1.11) <0.0001 1.10 (1.08 to 1.12) <0.0001 Atrial fibrillation 1.19 (1.16 to 1.22) <0.0001 1.20 (1.16 to 1.24) <0.0001 Smoking 1.09 (1.07 to 1.10) <0.0001 1.02 (1.01 to 1.04) 0.0006 Hospital grade (tertiary vs secondary) 0.98 (0.97 to 1.00) 0.0061 0.97 (0.96 to 0.99) <0.0001 Region, Western (reference) Eastern 0.95 (0.94 to 0.97) <0.0001 1.00 (0.98 to 1.02) 0.8113 Central 0.75 (0.74 to 0.76) <0.0001 0.81 (0.80 to 0.83) <0.0001 Admission NIHSS score (per 1-point increase)* — — 0.99 (0.99 to 0.99) <0.0001 The first column includes all patients; the second column is restricted to patients with available admission NIHSS scores.
*Admission NIHSS score not included due to missing data in 19.9% of patients.
DS, dysphagia screening; NIHSS, National Institute of Health Stroke Scale; SU, stroke unit; TIA, transient ischaemic attack.
- Table 3
Baseline characteristics of patients with and without pneumonia
Variables Total, n (%)
N=790 811Pneumonia, n (%)
N=64 398 (8.1%)No pneumonia, n (%)
N=726 413 (91.9%)ASD Age, mean (SE) 66.2 (12.0) 72.5 (11.3) 65.6 (11.9) 60.3 Male 494 756 (62.6) 39 435 (61.2) 455 321 (62.7) 3.1 Arrival by EMS 82 859 (10.5) 14 191 (22.0) 68 668 (9.5) 34.8 Admission NIHSS score, median (IQR)* 3.0 (2.0–6.0) 7.0 (3.0–13.0) 3.0 (1.0–5.0) 80.4 0–3 347 950 (44.0) 14 169 (22.0) 333 781 (45.9) 52.2 4–14 251 270 (31.8) 26 305 (40.8) 224 965 (31.0) 20.5 ≥15 34 051 (4.3) 11 424 (17.7) 22 627 (3.1) 49.3 Hospitalised in SUs 193 968 (24.5) 19 280 (29.9) 174 688 (24.0) 13.3 Medical history Stroke/TIA 263 769 (33.4) 25 103 (39.0) 238 666 (32.9) 12.7 Hypertension 509 975 (64.5) 41 991 (65.2) 467 984 (64.4) 1.7 Diabetes mellitus 170 334 (21.5) 13 879 (21.6) 156 455 (21.5) 0.2 Dyslipidaemia 61 111 (7.7) 5341 (8.3) 55 770 (7.7) 2.2 CHD/previous MI 69 357 (8.8) 8849 (13.7) 60 508 (8.3) 17.3 Atrial fibrillation 39 276 (5.0) 8649 (13.4) 30 627 (4.2) 32.9 Carotid stenosis 10 288 (1.3) 1202 (1.9) 9086 (1.3) 4.8 PVD 13 775 (1.7) 1824 (2.8) 11 951 (1.6) 8.2 Heart failure 7884 (1.0) 2198 (3.4) 5686 (0.8) 18.2 Dementia 3743 (0.5) 897 (1.4) 2846 (0.4) 10.6 Smoking 293 172 (37.1) 23 127 (35.9) 270 045 (37.2) 2.7 Alcoholism 185 420 (23.4) 13 755 (21.4) 171 665 (23.6) 5.3 DS performed prior to oral intake 622 718 (78.7) 54 745 (85.0) 567 973 (78.2) 17.6 Swallowing function Unknown† 171 110 (21.6) 9929 (15.4) 161 181 (22.2) 17.5 Normal 556 869 (70.4) 31 561 (49.0) 525 308 (72.3) 49.1 Dysphagia 62 832 (7.9) 22 908 (35.6) 39 924 (5.5) 80.3 Discharge outcomes In-hospital mortality 1662 (0.2) 1077 (1.7) 585 (0.1) 17.0 mRS score at discharge‡ 0–2 270 649 (34.2) 10 861 (16.9) 259 788 (35.8) 43.9 ≥3 119 908 (15.2) 18 957 (29.4) 100 951 (13.9) 38.3 Length of stay, median (IQR) 11.0 (8.0–14.0) 13.0 (9.0–18.0) 11.0 (8.0–14.0) 38.4 Region Eastern 367 586 (46.5) 30 417 (47.2) 337 169 (46.4) 1.6 Central 258 162 (32.6) 15 596 (24.2) 242 566 (33.4) 20.4 Western 165 063 (20.9) 18 385 (28.5) 146 678 (20.2) 19.4 Hospital grade Secondary 307 090 (38.8) 21 597 (33.5) 285 493 (39.3) 12.1 Tertiary 483 721 (61.2) 42 801 (66.5) 440 920 (60.7) 12.1 *The NIHSS score was missing in 157 540 (19.9%) cases.
†Unknown: Swallowing status was defined as unknown in patients without documentation of DS and those with missing swallowing function data.
‡The mRS score at discharge was missing in 400 254 (50.6%) patients.
.ASD, absolute standardised difference; CHD, coronary heart disease; DS, dysphagia screening; EMS, emergency medical services; MI, myocardial infarction; mRS, modified Rankin Scale; NIHSS, National Institute of Health Stroke Scale; PVD, peripheral vascular disease; SUs, stroke units; TIA, transient ischaemic attack.
- Table 4
Multivariable analysis of factors associated with pneumonia
Variable Patients with and without NIHSS scores, N=790 811 Patients with NIHSS scores, N=633 271 OR (95% CI) P value OR (95% CI) P value DS performed prior to oral intake 1.47 (1.29 to 1.67) <0.0001 1.65 (1.41 to 1.92) <0.0001 Swallowing function, normal (reference) Dysphagia 7.31 (7.15 to 7.46) <0.0001 5.00 (4.88 to 5.13) <0.0001 Unknown 1.52 (1.34 to 1.72) <0.0001 1.49 (1.28 to 1.74) <0.0001 Age (per 10 years) 1.56 (1.55 to 1.57) <0.0001 1.53 (1.51 to 1.54) <0.0001 Male (vs female) 1.15 (1.12 to 1.17) <0.0001 1.20 (1.17 to 1.23) <0.0001 Arrival by EMS 1.84 (1.79 to 1.88) <0.0001 1.47 (1.43 to 1.51) <0.0001 Hospitalised in SUs 1.17 (1.14 to 1.19) <0.0001 1.13 (1.10 to 1.15) <0.0001 Medical history Stroke/TIA 1.13 (1.11 to 1.15) <0.0001 1.09 (1.06 to 1.11) <0.0001 CHD/previous MI 1.26 (1.22 to 1.29) <0.0001 1.20 (1.16 to 1.24) <0.0001 Atrial fibrillation 1.68 (1.63 to 1.73) <0.0001 1.39 (1.34 to 1.44) <0.0001 Heart failure 2.02 (1.91 to 2.15) <0.0001 1.92 (1.80 to 2.05) <0.0001 Dementia 1.68 (1.54 to 1.83) <0.0001 1.57 (1.42 to 1.73) <0.0001 Smoking 1.12 (1.10 to 1.15) <0.0001 1.13 (1.11 to 1.16) <0.0001 Hospital grade (tertiary vs secondary) 1.17 (1.15 to 1.19) <0.0001 1.18 (1.15 to 1.20) <0.0001 Region, Western (reference) Eastern 0.70 (0.68 to 0.71) <0.0001 0.74 (0.72 to 0.76) <0.0001 Central 0.58 (0.57 to 0.60) <0.0001 0.59 (0.58 to 0.61) <0.0001 Admission NIHSS score (per 1-point increase)* — — 1.08 (1.07 to 1.08) <0.0001 The first column includes all patients; the second column is restricted to patients with admission NIHSS scores.
*Admission NIHSS score not included due to missing data in 157 540 (19.9%) of the patients.
CHD, coronary heart disease; DS, dysphagia screening; EMS, emergency medical services; MI, myocardial infarction; NIHSS, National Institute of Health Stroke Scale; SUs, stroke units; TIA, transient ischaemic attack.
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