{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T06:00:26Z","timestamp":1785218426886,"version":"3.55.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stroke-associated pneumonia (SAP) is a frequent and devastating complication after acute stroke. Although early dysphagia screening is strongly recommended by guidelines, its implementation is often delayed in the Neurological Intensive Care Unit (Neuro-ICU). The precise continuous dose\u2013response relationship between screening delay time and SAP risk has not been adequately quantified.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively enrolled 300 consecutive acute stroke patients admitted to the Neuro-ICU, excluding those requiring intubation within 24\u202fh to avoid reverse causation. Hierarchical multivariable logistic regression, adjusting for consciousness level (Glasgow Coma Scale, GCS) and systemic inflammation (categorical Neutrophil-to-Lymphocyte Ratio, NLR) while excluding clinical mediators, evaluated the association between delayed screening (&amp;gt;24\u202fh) and SAP. Restricted cubic spline (RCS) analysis modeled the non-linear dose\u2013response relationship with 4\u202fh as the reference point. Subgroup analyses used Firth\u2019s penalized regression to address separation bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall SAP incidence was 48.3%. In the fully adjusted model, delayed screening remained an independent risk factor for SAP (adjusted OR\u202f=\u202f3.69, 95% CI: 2.12\u20136.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The RCS curve showed a significant non-linear trajectory (\n                      <jats:italic>p<\/jats:italic>\n                      for non-linearity &amp;lt;0.05), with SAP odds remaining stable during the early buffer window but increasing steeply after the 24-h threshold. This effect was consistent across ischemic stroke (adjusted OR\u202f=\u202f3.10, 95% CI: 1.59\u20136.10) and hemorrhagic stroke (adjusted OR\u202f=\u202f4.69, 95% CI: 1.80\u201313.00) subgroups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delayed dysphagia screening beyond 24\u202fh was associated with a non-linear increase in the odds of SAP. The 24-h mark may represent a clinically relevant risk threshold, although residual confounding cannot be excluded.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1895263","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:37:51Z","timestamp":1785217071000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association of delayed swallow screening with stroke-associated pneumonia and in-hospital outcomes in acute stroke patients in the neurocritical care unit"],"prefix":"10.3389","volume":"13","author":[{"given":"Bo","family":"Gao","sequence":"first","affiliation":[{"name":"The Neurocritical Care Unit, Zhengzhou People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongya","family":"Zhuo","sequence":"additional","affiliation":[{"name":"The Neurocritical Care Unit, Zhengzhou People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yingying","family":"Sun","sequence":"additional","affiliation":[{"name":"The Neurocritical Care Unit, Zhengzhou People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kun","family":"Zhang","sequence":"additional","affiliation":[{"name":"The Neurocritical Care Unit, Zhengzhou People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujie","family":"Yang","sequence":"additional","affiliation":[{"name":"The Neurocritical Care Unit, Zhengzhou People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pan","family":"Wang","sequence":"additional","affiliation":[{"name":"The Neurocritical Care Unit, Zhengzhou People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Runan","family":"Ren","sequence":"additional","affiliation":[{"name":"The Neurocritical Care Unit, Zhengzhou People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guolan","family":"Xu","sequence":"additional","affiliation":[{"name":"The Neurocritical Care Unit, Zhengzhou People\u2019s Hospital","place":["Zhengzhou, Henan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the global burden of disease study 2019","volume":"20","year":"2021","journal-title":"Lancet Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e254","DOI":"10.1161\/CIR.0000000000000950","article-title":"Heart disease and stroke Statistics-2021 update: a report from the American Heart Association","volume":"143","author":"Virani","year":"2021","journal-title":"Circulation"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"129","DOI":"10.1016\/S0140-6736(20)31179-X","article-title":"Stroke","volume":"396","author":"Campbell","year":"2020","journal-title":"Lancet"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1202","DOI":"10.1161\/STROKEAHA.114.007843","article-title":"How is pneumonia diagnosed in clinical stroke research? A systematic review and meta-analysis","volume":"46","author":"Kishore","year":"2015","journal-title":"Stroke"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1212\/WNL.0b013e31823152b1","article-title":"Risk factors, inpatient care, and outcomes of pneumonia after ischemic stroke","volume":"77","author":"Finlayson","year":"2011","journal-title":"Neurology"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1159\/000350199","article-title":"Stroke-associated pneumonia: major advances and obstacles","volume":"35","author":"Hannawi","year":"2013","journal-title":"Cerebrovasc Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2756","DOI":"10.1161\/01.STR.0000190056.76543.eb","article-title":"Dysphagia after stroke: incidence, diagnosis, and pulmonary complications","volume":"36","author":"Martino","year":"2005","journal-title":"Stroke"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1177\/1747493016639057","article-title":"Post-stroke dysphagia: a review and design considerations for future trials","volume":"11","author":"Cohen","year":"2016","journal-title":"Int J Stroke"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1161\/STROKEAHA.115.009617","article-title":"Diagnosis of stroke-associated pneumonia: recommendations from the pneumonia in stroke consensus group","volume":"46","author":"Smith","year":"2015","journal-title":"Stroke"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000211","article-title":"Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"50","author":"Powers","year":"2019","journal-title":"Stroke"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"2583","DOI":"10.1161\/STROKEAHA.117.018157","article-title":"Early dysphagia screening by trained nurses reduces pneumonia rate in stroke patients: a clinical intervention study","volume":"48","author":"Palli","year":"2017","journal-title":"Stroke"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"3154","DOI":"10.1161\/STROKEAHA.111.000204","article-title":"Prospective quality initiative to maximize dysphagia screening reduces hospital-acquired pneumonia prevalence in patients with stroke","volume":"44","author":"Titsworth","year":"2013","journal-title":"Stroke"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"900","DOI":"10.1161\/STROKEAHA.116.015332","article-title":"Predictors and outcomes of dysphagia screening after acute ischemic stroke","volume":"48","author":"Joundi","year":"2017","journal-title":"Stroke"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1159\/000492730","article-title":"Impact of dysphagia assessment and management on risk of stroke-associated pneumonia: a systematic review","volume":"46","author":"Eltringham","year":"2018","journal-title":"Cerebrovasc Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1136\/jnnp-2016-313356","article-title":"The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia","volume":"88","author":"Bray","year":"2017","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"ref16","doi-asserted-by":"crossref","DOI":"10.1007\/978-1-4757-3462-1","volume-title":"Regression Modeling Strategies: with Applications to Linear Models, Logistic Regression, and Survival Analysis","author":"Harrell","year":"2001"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1016\/S0140-6736(25)01637-X","article-title":"Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the global burden of disease study 2023","volume":"406","year":"2025","journal-title":"Lancet"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e344","DOI":"10.1161\/STR.0000000000000513","article-title":"2026 guideline for the early management of patients with acute ischemic stroke: a guideline from the American Heart Association\/American Stroke Association","volume":"50","author":"Prabhakaran","year":"2026","journal-title":"Stroke"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.archger.2011.06.029","article-title":"Prevention of aspiration pneumonia (AP) with oral care","volume":"55","author":"Tada","year":"2012","journal-title":"Arch Gerontol Geriatr"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1886","DOI":"10.1161\/STROKEAHA.118.021228","article-title":"High neutrophil-to-lymphocyte ratio predicts stroke-associated pneumonia","volume":"49","author":"Nam","year":"2018","journal-title":"Stroke"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1038\/nrn1765","article-title":"Central nervous system injury-induced immune deficiency syndrome","volume":"6","author":"Meisel","year":"2005","journal-title":"Nat Rev Neurosci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1186\/s12877-022-02960-5","article-title":"Prevalence of dysphagia and risk of pneumonia and mortality in acute stroke patients: a meta-analysis","volume":"22","author":"Banda","year":"2022","journal-title":"BMC Geriatr"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1186\/s12877-023-04310-5","article-title":"Development and validation of a nomogram model for prediction of stroke-associated pneumonia associated with intracerebral hemorrhage","volume":"23","author":"Wang","year":"2023","journal-title":"BMC Geriatr"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2921","DOI":"10.1161\/STROKEAHA.120.032615","article-title":"Association of Lesion Pattern and Dysphagia in acute intracerebral hemorrhage","volume":"52","author":"Hess","year":"2021","journal-title":"Stroke"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"103588","DOI":"10.1016\/j.ijnurstu.2020.103588","article-title":"The Gugging swallowing screen in dysphagia screening for patients with stroke: a systematic review","volume":"107","author":"Park","year":"2020","journal-title":"Int J Nurs Stud"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1895263\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T05:37:52Z","timestamp":1785217072000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1895263\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":25,"alternative-id":["10.3389\/fmed.2026.1895263"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1895263","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"article-number":"1895263"}}