Abstract
BackgroundDysphagia is common after stroke. Patients with dysphagia have a higher risk of stroke-associated pneumonia (SAP) and poor outcomes. Early detection of dysphagia is necessary to identify and manage patients at high risk of aspiration. The aim of the study was to assess the impact of the systematic administration of the volume-viscosity swallow test (V-VST) in patients with acute ischaemic stroke.MethodsThis was a retrospective observational study that enrolled patients with acute ischaemic stroke in two consecutive time periods: pre-V-VST, when the 30-mL water-swallowing test (WST) was systematically administered, and V-VST, when all patients underwent the WST and the V-VST test was systematically administered if the patient failed the WST.ResultsTwo hundred and 42 patients were enrolled. The mean age of the participants was 68.8 ± 10.88 years, 61.2% were male, and the median National Institutes of Health Stroke Scale score was 3 (IQR, 1–6). A total of 147 patients were enrolled during the pre-V-VST period and 95 were enrolled during the V-VST period. There was a significant difference in the occurrence of SAP (21.8% vs. 10.5%, p = 0.024) and the rate of nasogastric tube feeding (25.9% vs. 14.7%, p = 0.040) between the two groups, and no differences were found in the length of hospital stay (p = 0.277) or the total cost of hospitalization (p = 0.846).ConclusionsThe V-VST was a better clinical screening tool, and it can also provide detailed suggestions regarding dietary modifications to prevent aspiration and SAP.
Highlights
Patients were screened by the water-swallowing test (WST) or the WST first followed by the volume-viscosity swallow test (V-VST)
A total of 242 patients with acute ischaemic stroke were enrolled, 147 of whom were enrolled during the pre-V-VST period and 95 of whom were enrolled during the V-VST period
There was a significant difference in the occurrence of stroke-associated pneumonia (SAP) and nasogastric tube feeding in patients with acute ischaemic stroke when compared with that when 30 ml WST systematically administered
Summary
Patients with dysphagia have a higher risk of stroke-associated pneumonia (SAP) and poor outcomes. Detection of dysphagia is necessary to identify and manage patients at high risk of aspiration. Poststroke dysphagia, or impaired swallowing, is a common complication of acute stroke and a risk factor for airway aspiration and stroke-associated. Aspiration pneumonia caused by dysphagia is a potentially preventable hospital-acquired condition [1]. Detection and intervention are necessary to prevent dysphagia-related pneumonia [16]. Swallowing screening after stroke is performed to identify patients with dysphagia who are at risk of aspiration when swallowing using assessment tools with high sensitivity so that professionals can evaluate and intervene further to prevent SAP [24]. Several screening tools with different strengths and limitations have been developed for this purpose, but choosing which one to use depends on the local health resources [7]
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