Abstract 196: Compounded Point-Scoring Of Dysphagia Risk Factors Predict Clinical Dysphagia In An Acute Care Hospital Setting

Abstract

Compounded Point-Scoring Of Dysphagia Risk Factors Predict Clinical Dysphagia In An Acute Care Hospital Setting Introduction Dysphagia places patients at risk for malnutrition, dehydration, and pulmonary aspiration; reduces quality of life; and lengthens hospitalization. The published literature describes individual dysphagia risks factors (DRF) . We felt that in many patients, the risk would be given by the number and types of DRF. Further, each risk factor could have its own independent contribution to the dysphagia. Hypothesis Can the risk of dysphagia be identified with a simple screening questionnaire where the clinical DRF are numerically weighed-scored, and later compounded? Methods Individual DRF (n=21) were each weighed from 1 to 5. The decision on the assigned score was given by 3 individual experts, the values averaged. • A score of 0 means that no dysphagia risk factors were present. • A score 1-4 means that some DRF are present, but the risk probably low. It prompts the bedside nurse to administer standardized swallowing trials. (video available in vimeo.com/speechpathology). • A score ≥5 signifies high risk for aspiration. The patient is placed in full-NPO status, and the Speech Language Pathology (SLP) service is consulted for a bedside swallowing evaluation (BSE). Patients admitted to floors where stroke patients would be admitted more commonly were given the Swallowing Safety Screening (SSS) by the trained bedside nurse. The SSS has 2 components the 1) scoring, and 2) the administration of swallowing trials. Here, we report on the scoring component of the SSS. Results SSS was reviewed for 357 patients (n=357) who were referred to the SLP. Patients on SLP’s caseload were reviewed in a blinded, time-limited, non-randomized fashion. Data was collected for patients for whom a SSS had been completed, and a BSE had been triggered (n=133). Of patients in this subset (n=114) who scored ≥5 on the SSS, 70% were judged positive for the presence of dysphagia, 30% were negative. Further analysis of the data reveals that the mean SSS score for negative dysphagia diagnoses is <6.1, and for positive dysphagia diagnoses is >7.95. The confidence intervals (95%) are 1.29 and 1.4, respectively. Using z statistics, the probability of getting this separation of the data by chance is p =0.00014. Conclusions It is possible to identify dysphagia patients using a questionnaire where the DRF are given a numerical weight and then summated. There is a point where the score of the DRF adds such clinical weight that dysphagia is identified or predicted.