A videoendoscopic swallowing examination using a scoring system for prediction of successful oral intake after discharge from an acute care hospital

Abstract

It is often difficult to decide whether to restart an oral diet during acute hospitalization. We investigated retrospectively the predictive factors for successful oral intake after discharge from an acute care hospital or transfer to a recovery rehabilitation hospital. A total of 45 inpatients were enrolled, presenting with dysphagia due to various diseases during hospitalization in an acute care hospital. Between October 2011 and December 2012 the patients were examined with a videoendoscopic examination of swallowing (VE). We classified the feeding procedure after discharge from the hospital into three groups-the first group (group 1) had no oral intake limitation, the second group (group 2) had limited oral intake, and the third group (group 3) had no oral intake ability. We then assessed the factors of age, sex, VE score, and functional independence measure (FIM) score to compare the activities of daily living (ADL) between group 1 and group 2 + 3. FIM score consists of motor and cognitive scores. We observed a statistically significant difference in age, VE score, motor FIM score and cognitive FIM score in a univariate analysis (p = 0.03, p = 0.0036, p = 0.0019, p = 0.0125). The VE score also showed a statistically significant difference in a multivariate analysis (p = 0.0396), indicating that the VE score was an independent variable related to prediction of the feeding procedure. A VE score of 4 as the cut-off point between group 1 and group 2 + 3 provided a specificity of 0.944 and a positive predictive value of 0.923. On the other hand, a VE score of 9 as the cut-off point between group 3 and group 1 + 2 provided a specificity of 0.969 and a positive predictive value of 0.857. These results indicate that the VE score is a useful tool for the prediction of successful oral intake after discharge from an acute care hospital. In addition, age and ADL are also useful predictive factors for the feeding procedure.