Flexible endoscopic evaluation of swallowing vs. screening tests for dysphagia and their effect on the final outcome in post-acute stroke patients (original) (raw)
Related papers
Annals of Indian Academy of Neurology, 2013
As with many other neurological disorders, stroke often leads to an impairment of the swallowing mechanism. There is a proven high incidence of aspiration with the potential to cause pneumonia. [3,4] This is a significant factor causing mortality in stroke. Hence, care needs to be taken by the treating stroke team to prevent this complication. The initial management of dysphagia in stroke often consists of the insertion of a naso-gastric tube (NGT). This is followed by bedside assessment of the return of normal swallowing process, and decision for NGT removal. While this suffices in most cases, occasionally there exists a doubt about aspiration. This necessitates a more precise method of evaluation. Here, two modalities have been described: Flexible endoscopic evaluation of swallowing (FEES) and video-fluoroscopic study of swallowing (VFSS). It is our contention that FEES suffices to look for laryngeal penetration of oral feeds and to take the final decision about NGT removal, in those patients at risk. We present a report of our experience with FEES assessment. Also, we have
Incidence of Dysphagia in Acute Stroke Patients: An Early Screening and Management
International Journal of Phonosurgery & Laryngology, 2021
Original research language pathologist in which various maneuvers could be elicited on patients to assess which method would be more helpful in improving their symptom. During FEES, we closely monitored SPO 2 (oxygen saturation) of our patients. The three scales considered were penetration aspiration scale, secretion rating scale, and residue rating scale. According to the severity of score, patients were given compensatory and rehabilitative swallowing therapy. • Stroke severity was assessed by NIHSS score. • Location of stroke was done on the basis of computed tomography (CT) scan of the brain. The primary aim of our study was to assess the incidence of dysphagia in acute stroke patients and analyze the benefits of early screening and management. Statistical Analysis Data were expressed as number (%) and compared using Wilcoxon signed-rank test. The two groups (patients with dysphagia vs • Fiber-optic endoscopic evaluation of swallowing (FEES): 3 We performed this procedure along with our speech and
European Stroke Journal
Post-stroke dysphagia (PSD) is present in more than 50 % of acute stroke patients, increases the risk of complications, in particular aspiration pneumonia, malnutrition and dehydration, and is linked to poor outcome and mortality. The aim of this guideline is to assist all members of the multidisciplinary team in their management of patients with PSD. These guidelines were developed based on the European Stroke Organisation (ESO) standard operating procedure and followed the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. An interdisciplinary working group identified 20 relevant questions, performed systematic reviews and meta-analyses of the literature, assessed the quality of the available evidence, and wrote evidence-based recommendations. Expert opinion was provided if not enough evidence was available to provide recommendations based on the GRADE approach. We found moderate quality of evidence to recommend dysphagia screening in all stroke ...
Geriatrics
The international approach to the assessment and management of dysphagia in the acute phase post stroke is little studied. A questionnaire was sent to clinicians in stroke services that explored the current practice in dysphagia screening, assessment, and management within the acute phase post stroke. The findings from four (the UK, the US, Canada, and Australia) of the 22 countries returning data are analysed. Consistent approaches to dysphagia screening and the modification of food and liquid were identified across all four countries. The timing of videofluoroscopy (VFS) assessment was significantly different, with the US utilising this assessment earlier post stroke. Compensatory and Postural techniques were employed significantly more by Canada and the US than the UK and Australia. Only food and fluid modification, tongue exercises, effortful swallow and chin down/tuck were employed by more than fifty percent of all respondents. The techniques used for assessment and management ...
Dysphagia Screening Protocol For Acute Stroke Patient: A Literature Review
2021
Background: Nearly two-thirds of acute stroke patients have dysphagia. Dysphagia defined as difficulty in swallowing of liquids or food, vary in severity with symptoms ranging from mild throat discomfort to inability to eat. It's well known that dysphagia is associated with aspiration pneumonia, dehydration, malnutrition, prolonged length of stay, and increased mortality. Early screening reduces pneumonia rates in stroke and it is usually performed by nurses. Dysphagia screening is recommended but no protocol or tool is pointed. Aim: the aim of this study is to conduct a literature review of dysphagia screening for stroke patient Methods: Literature search three databases (Scopus, Proquest, and Science Direct), with the keywords "Dysphagia" AND "Stroke" AND "Nursing", published in English between 2019 and 2021. Result: Twenty five publications relating to dysphagia screening met the inclusion criteria. There are five methods of dysphagia screening performed by nurses or other health workers: 1) a simple Questionnaire Test (4QT) method, which is by asking the following four questions: does the patient cough or choke while eating or drinking; whether the patient takes longer than usual to eat; does the patient change the thickness of the food to be able to swallow, and whether the voice turns hoarse after eating or drinking; 2) Water Swallow Test (WST) method; 3) Bed Side Screening Tool for Dysphagia (BSTD) method; 4) Volume Viscosity Swallow Test (V-VST) method, namely modification of feeding with first pudding, nectar and finally water; 5) Simplified Cough Test Method. The five screening methods for dysphagia above have been tested for sensitivity and specificity, as well as positive and negative predictive values Conclusion: screening is a first step in the identification of swallowing impairment or dysphagia of stroke patient. Dysphagia is an independent predictor of poor patient outcome and prolonged recovery time. Nurse has an important role to conduct a screening and must ensure that the selected tools has high reliability and concurrent validity.
Fiberoptic Endoscopic Examination of Swallowing (FEES) Evaluation in Post Stroke Patients
Bioscientia Medicina : Journal of Biomedicine and Translational Research
Introduction. Complications caused by post-stroke dysphagia increase the morbidity and mortality of patients. Although it has a significant effect on the functional abilities and worsening of the patient's prognosis, post-stroke dysphagia is still under-noticed and often undiagnosed. The importance of knowing the incidence of post-stroke dysphagia, not only to determine its relationship to the pathology of the disease but also to determine treatment plans or follow-up interventions. This study aims to determine the incidence of FEES findings in post-stroke dysphagia both hemorrhagic and non-hemorrhagic stroke. Methods. Forty post-stroke patients in the Inpatient and Outpatient Installation of the THTKL Section and the Neurology Section of Dr. Hospital. Mohammad Hoesin Palembang conducted a FEES examination to see leakage, residue, penetration, and aspiration after being given six different types of food boluses ranging from filter porridge, rice porridge, oatmeal, water, milk, a...
Dysphagia Bedside Screening for Acute-Stroke Patients: The Gugging Swallowing Screen
Stroke, 2007
Background and Purpose— Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows a graded rating with separate evaluations for nonfluid and fluid nutrition starting with nonfluid textures. The Gugging Swallowing Screen (GUSS) aims at reducing the risk of aspiration during the test to a minimum; it assesses the severity of aspiration risk and recommends a special diet accordingly. Methods— Fifty acute-stroke patients were assessed prospectively. The validity of the GUSS was established by fiberoptic endoscopic evaluation of swallowing. For interrater reliability, 2 independent therapists evaluated 20 patients within a 2-hour period. For external validity, another group of 30 patients was tested by stroke nurses. For content validity, the liquid score of the fiberoptic endoscopic evaluation of swallow...
Screening for Oropharyngeal Dysphagia in Stroke: Insufficient Evidence for Guidelines
Dysphagia, 2000
To systematically review and evaluate current peer-reviewed published literature to determine whether there is sufficient evidence to recommend bedside clinical screening guidelines for oropharyngeal dysphagia in adults with stroke. Searching MEDLINE, HealthSTAR and CINAHL were searched to July 1997 for peer-reviewed articles in the English language, using the keywords 'cerebrovascular disorders' and 'deglutition disorders'. In addition, relevant Internet addresses, including the Cochrane Collaboration and the U.S. National Library of Medicine sites, were searched and extensive handsearches of the bibliographies of identified articles were conducted. Relevant journal were also handsearched. Study selection Study designs of evaluations included in the review Accuracy of screening: editorials, review articles and single-patient case studies were ineligible for inclusion in the review. This section of the review included prospective diagnostic case-control studies, and retrospective and prospective diagnostic cohort studies. Patient benefits: only comparative studies were deemed eligible for this section of the review. Non-randomised trials using data from historical controls were included. Specific interventions included in the review Bedside screening tools to assess oropharyngeal dysphagia, which were noninvasive and easily administered, were eligible for inclusion. A range of clinical signs were assessed in the review. These included oral signs, oropharyngeal signs, laryngeal signs and other clinical neuropharyngeal signs. Diagnostic interventions requiring specialised equipment or specialist expertise were not eligible for inclusion in the review. Patient-reported symptoms were excluded. Reference standard test against which the new test was compared Studies that used videofluoroscopy as the reference standard for the diagnosis of dysphagia were eligible for inclusion in the review. Participants included in the review Studies were eligible for the review if they investigated adult patients (greater than 18 years of age) in acute, chronic or rehabilitation settings. Studies of dysphagia owing to other causes were excluded. Outcomes assessed in the review The outcomes of interest in the review were categorised into two groups: outcomes relating to the accuracy of screening and outcomes relating to the benefit to patients who were screened. Accuracy of screening: the outcomes evaluated were sensitivity, specificity and positive likelihood ratios. Where sufficient data to calculate these parameters were not presented, the parameter was excluded from the review. Patient benefits: the outcomes included those relating to health and illness, to functioning and to cost. How were decisions on the relevance of primary studies made?
Dysphagia Screening: State of the Art
Stroke, 2013
D ysphagia screening is a recurring topic of discussion in stroke care and other acute and chronic conditions that can affect swallowing. Many would agree with Wolf and Rudd that "[s]wallowing screening is so obviously important that a trial is not needed, but the hard evidence that screening saves lives is absent." 1 Paradoxically, the 2010 Joint Commission retired the dysphagia screening performance standard for acute stroke because the National Quality Forum could not endorse it, stating that there are no standards for what constitutes a valid dysphagia screening tool, and no clinical trials have been completed that identify the optimal swallow screening. 2 Consequently, dysphagia screening was removed from the "Get With The Guidelines" stroke guidelines. This has led to concern among multidisciplinary stroke professionals that dysphagia screening will be entirely omitted from stroke care, leading to worsening outcomes among stroke patients at risk for swallowing problems. An invitational symposium was held January 31, 2012, at the State-ofthe-Art Nursing Symposium in New Orleans, LA, to explore the issues and state of the science in dysphagia screening. The present report serves as a conference proceeding that aims to (1) educate multidisciplinary stroke professionals about the important issues related to identifying valid and reliable dysphagia screening tools, (2) identify the strengths and limitations of currently available dysphagia screenings, (3) describe how facilities may make cogent decisions about dysphagia screening selection, based on their specific needs, and (4) provide an example for establishing a dysphagia screening in a stroke care unit. As part of the discussion during the symposium, several expert recommendations were made regarding dysphagia screening in stroke care, which are also presented here. We will begin the report, as we will end, with this caveat: Because dysphagia screening is not a "one size fits all" process, neither the symposium nor the present report aimed to suggest that a single tool will meet the needs of multidisciplinary stroke professionals at every level of stroke care. Why Is Dysphagia Identification Important? Stroke is the leading neurological cause of dysphagia (difficulty swallowing), with 42% to 67% of patients presenting with dysphagia within 3 days of stroke. Fifty percent of these patients aspirate, and one third of patients who aspirate develop pneumonia that requires treatment. 3 In addition, swallowing abnormality is associated with a 3-fold higher mortality rate, largely attributable to pneumonia. Early identification of dysphagia and aspiration risk is critical to avoid adverse health consequences for stroke patients. These adverse health consequences include not only aspiration and pneumonia but also dehydration, malnutrition, weight loss, and susceptibility to other illnesses, as well as death. 4 Furthermore, these dysphagia-related adverse health consequences may lead to reduced patient satisfaction caused by the length of time spent nil per os (NPO), longer length of hospital stay, reduced ability to participate in rehabilitation, and reduced level of independence at discharge.
Stroke, 2009
Background and Purpose-Dysphagia occurs in 55% of all acute stroke patients. Early identification of dysphagia from screening can lead to earlier treatments and thereby reduce complications. We designed and validated a new bedside dysphagia screening tool-the Toronto Bedside Swallowing Screening Test (TOR-BSST) for stroke survivors in acute and rehabilitative settings. Methods-The TOR-BSST initially contained 5 items with proven high predictive ability for dysphagia. Trained screeners administer and score the TOR-BSST in less than 10 minutes. Trained nurses from 2 acute and 2 rehabilitation facilities administered the TOR-BSST to consecutively admitted stroke inpatients. A positive screen identified patients at risk for dysphagia. Blinded repeat screenings were conducted within 24 hours. Test-retest reliability was established with the first 50 administrations at an ICCϭ0.92 (CI, 0.85 to 0.96). Items were eliminated if they contributed Յ5% to the total score and were judged clinically impractical. 20% of all enrolled patients were randomly allocated to gold standard videofluoroscopic assessment of swallowing and findings rated independently by 4 blinded experts. Adequate validity was set at sensitivity Ն90% and negative predictive value Ն90%. Results-311 stroke inpatients were enrolled; 103 acute and 208 rehabilitation. Screening was positive in 59.2% acute and 38.5% rehabilitation patients. The pharyngeal sensation item did not meet inclusion criteria and was eliminated. The TOR-BSST demonstrated excellent validity with sensitivity at 91.3% (CI, 71.9 to 98.7), and negative predictive values at 93.3% in acute and 89.5% in rehabilitation settings.