Priority 8 Stroke Prevention, Diagnosis, Pre-hospital and Hospital Care

UNCERTAINTY: How can complications of stroke be reduced (e.g. pneumonia)?  (JLA PSP Priority 8)
Overall ranking 8
JLA question ID 0106/8a
Explanatory note

Complications occur frequently after stroke and have an adverse effect on outcomes. For example, patients with dysphagia are at an increased risk of stroke-associated pneumonia. A 2018 Cochrane review looked at the effectiveness of using antibiotics preventatively and although overall infections reduced there was no effect on functional outcome, mortality or pneumonia (see evidence). A 2020 review (see Evidence) looked at the effects of oral hygiene care on incidence of ventilator‐associated pneumonia in critically ill patients. It concluded that there is insufficient evidence to determine whether any of the interventions evaluated in the studies are associated with adverse effects.

A new trial starting in 2021 may partially address this question. However evidence is needed on effective interventions to reduce complications in stroke patients to improve outcomes.

Evidence

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008530.pub3/full
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008367.pub4/full
https://www.karger.com/Article/FullText/492730 

Health Research Classification System category Stroke
Extra information provided by this PSP
Original uncertainty examples How can we reduce complications after stroke such as pneumonia? 
Submitted by  Health/Social Care professional x 1
PSP information
PSP unique ID 0106
PSP name Stroke prevention, diagnosis, pre-hospital and hospital care
Total number of uncertainties identified by this PSP. 93  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 30th April 2021