Implementing Cough Reflex Testing in a Clinical Pathway for Acute Stroke: A Pragmatic Randomised Controlled Trial

Area of Science:

• Neurology
• Clinical Medicine
• Public Health

Background:

• Silent aspiration is a common complication post-stroke, increasing pneumonia risk.
• Standard bedside dysphagia assessments are insufficient for predicting silent aspiration.
• Cough reflex testing (CRT) has emerged as a potential tool for identifying at-risk patients.

Purpose of the Study:

• To evaluate the impact of integrating cough reflex testing (CRT) into a clinical pathway for acute stroke patients.
• To assess the effect of CRT on patient outcomes, including pneumonia rates and length of hospital stay.
• To determine the feasibility and satisfaction associated with implementing a CRT pathway.

Main Methods:

• A randomized controlled trial involving 488 acute stroke patients.
• Patients were allocated to either a cough reflex testing (CRT) pathway or standard care (bedside assessment).
• Primary outcomes measured were confirmed pneumonia within 3 months and acute inpatient length of stay.

Main Results:

• A non-significant reduction in pneumonia rates (2.2%) was observed in the CRT group.
• No significant difference in length of acute inpatient stay was found between groups.
• CRT pathway implementation led to high clinician and patient satisfaction, with increased clinician confidence in dysphagia management.

Conclusions:

• Integrating cough reflex testing (CRT) into a clinical pathway is feasible with minimal resource increase.
• While clinicians perceive CRT as beneficial for decision-making, its efficacy in reducing pneumonia rates post-stroke needs further investigation.
• The study highlights the potential of CRT but underscores the need for more evidence on its clinical effectiveness.