Dysphagia In Acute Stroke Patients Research Articles

Prevalence of Dysphagia in Acute Stroke Patients: Cross Section Study

Prevalence of Dysphagia in Acute Stroke Patients: Cross Section Study

Validity and Reliability of the Swedish Version of the Gugging Swallowing Screen for use in Acute Stroke Care.

The purpose of this study was to cross-culturally validate the Swedish version of the Gugging Swallowing Screen (GUSS-S) for use in the acute phase of stroke. Further, to evaluate the inter-rater reliability between different healthcare professionals. GUSS was translated into Swedish using a forward-backward method followed by expert rating to obtain content validity. For criterion validity, the GUSS-S score was compared with Flexible Endoscopic Evaluation of Swallowing (FEES) assessed with the Penetration-Aspiration Scale (PAS) in acute stroke patients (≤ 96h after stroke onset). Convergent validity was calculated by comparison with the Functional Oral Intake Scale (FOIS) as per the comprehensive FEES assessment, the Standardized Swallowing Assessment (SSA), and the National Institutes of Health Stroke Scale (NIHSS). To evaluate inter-rater reliability, a nurse and a speech-language pathologist (SLP) independently assessed 30 patients. In total, 80 patients (32 women, median age 77 years (range 29-93) were included, mean 1.7 ± 0.9 days after admission. With a cut-off value of 14 points, the GUSS-S identified aspiration with a sensitivity of 100% and a specificity of 73% (area under the curve: 0.87, 95% CI 0.78-0.95). Spearman rank correlation showed very strong correlation between the GUSS-S and PAS (rs=-0.718, P = < 0.001) and FOIS (rs=0.720, P = 0.001) and strong correlation between the GUSS-S and SSA (rs=0.545, P = < 0.001) and NIHSS (rs=-0.447, P = 0.001). The inter-rater agreement for GUSS-S was substantial (Kw=0.67, P = < 0.001). The results indicate that the GUSS-S is a valid and reliable tool for the assessment of dysphagia in acute stroke patients by different healthcare professionals.

The Preventive Effect of Dysphagia Screening on Pneumonia in Acute Stroke Patients: A Systematic Review and Meta-Analysis.

(1) Background: Dysphagia is common in acute stroke patients and is a major risk factor for aspiration pneumonia. We investigated whether the early detection of dysphagia in stroke patients through screening could prevent the development of pneumonia and reduce mortality; (2) Methods: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for relevant studies published up to November 2021. We included studies that performed dysphagia screening in acute stroke patients and evaluated whether it could prevent pneumonia and reduce mortality rates. The methodological quality of individual studies was evaluated using the Risk Of Bias In Non-randomized Studies of Interventions tool, and publication bias was evaluated by the funnel plot and Egger’s test; (3) Results: Of the 6593 identified studies, six studies met the inclusion criteria for analysis. The screening group had a significantly lower incidence of pneumonia than the nonscreening group did (odds ratio (OR), 0.60; 95% confidence interval (CI), 0.42 to 0.84; p = 0.003; I2, 66%). There was no significant difference in mortality rate between the two groups (OR, 0.61; 95% CI, 0.33 to 1.13; p = 0.11; I2, 93%); (4) Conclusions: Early screening for dysphagia in acute stroke patients can prevent the development of pneumonia.

Incidence of Dysphagia in Acute Stroke Patients: An Early Screening and Management

Incidence of Dysphagia in Acute Stroke Patients: An Early Screening and Management

Diagnostic Accuracy of a Bedside Screening Tool for Dysphagia (BSTD) in Acute Stroke Patients

Background and purposean estimated 40-80% of acute ischemic stroke patients have dysphagia and about 14% develop stroke-associated pneumonia. However, it may be difficult to detect swallowing problems at admission. Moreover, there might not be an on-duty specialist skilled in the diagnosis of this condition. This study aimed at developing a user-friendly bedside examination to identify the risk of dysphagia in stroke patients at hospital admission. Methodsa diagnostic accuracy study was carried out to assess the concurrent validity of a simple Bedside Screening Tool for Dysphagia (BSTD) in acute stroke. All the consecutive stroke patients admitted between January and April 2018 were enrolled. Sensitivity, specificity, positive (PPV), negative predictive values (NPV) and the Cohen K concordance index scores, reported by nurses and speech-pathologists, were assessed. Resultsa total of 67/120 patients (55.8%) were male; overall average age was 67.4 (range 45-91) and 80.8% of the whole population had a history of ischemic stroke. The nursing staff identified 33.3% of dysphagia cases at admission and the speech pathologists 30%. The Cohen K was 0.92 (optimal concordance when K was > 0.8), sensitivity was 100%, specificity 95.2%, PPV 90% and NPV 100%. Conclusionsour BSTD had a 100% negative predictive value, indicating that this screening test is very useful in ruling out/confirming dysphagia in acute stroke patients

Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS): a prospective, blind, randomized and controlled clinical trial.

Dysphagia is common in acute stroke and leads to worse overall outcome. Transesophageal echocardiography (TEE) is used in the diagnostic evaluation of stroke with regard to its etiology and is a known cause of postoperative dysphagia in cardiac surgery. The prevalence of dysphagia in acute stroke patients undergoing TEE remains unknown. The aim of the Transesophageal Echocardiography - Dysphagia Risk in Acute Stroke (TEDRAS) study was to assess the influence of TEE on swallowing among patients who have experienced acute stroke. The TEDRAS study was a prospective, blind, randomized, controlled trial that included two groups of patients with acute stroke. Simple unrestricted randomization was performed, and examiners were blinded to each other's results. Swallowing was tested using flexible endoscopic evaluation of swallowing (FEES) at three different time points in the intervention group (24h before, immediately after and 24h after TEE) and in the control group (FEES on three consecutive days and TEE earliest after the third FEES). Validated scales were used to assess dysphagia severity for all time points as primary outcome measures. A total of 34 patients were randomized: 19 to the intervention group and 15 to the control group. The key findings of the repeated-measures between-group comparisons were significant increases in the intervention group for the following dysphagia measures: (1) secretion severity score (immediately after TEE: P<0.001; 24h after TEE: P<0.001) and (2) Penetration-Aspiration Scale score for saliva (immediately after TEE: P<0.001; 24h after TEE: P=0.007), for small (immediately after TEE: P=0.009) and large liquid boli (immediately after TEE: P=0.009; 24h after TEE: P=0.025). The results indicate a negative influence of TEE on swallowing in acute stroke patients for at least 24 hours.

Nurses' preferred items for dysphagia screening in acute stroke patients: A qualitative study

Background &amp; Aim: Formal dysphagia screening protocols are not yet implemented in some hospitals although there is growing evidence that early dysphagia screening reduces pneumonia rates in stroke patients. Trained professionals are not often available outside weekdays working hours in stroke units, meaning that early screening is usually performed by nurses that use informal detection to screen dysphagia in acute stroke patients. The purpose of this study was to identify which items stroke nurses prioritize in their clinical practice to screen dysphagia in acute stroke patients. Methods &amp; Materials: A qualitative study was developed using a focus group technique in five stroke units with a total of 20 stroke nurses selected by purposive sampling in march 2019. Qualitative Data Analysis Software Miner Lite 4.0 was used to assist in content analysis. Results: Two categories emerged: clinical data and swallowing and non-swallowing signs, each with a set of dimensions. In the category clinical data, relevance was noted for the dimension Glasgow Coma Scale and sex, identified as the most and least relevant, respectively, for dysphagia screening. In the category swallowing and non-swallowing signs no relevance evolved for preferred items. However, in this category, data suggest that nurses find less relevant in clinical practice speech disorders for dysphagia screening. Conclusions: Results reinforce the importance of a standardized approach through the use of valid and reliable dysphagia screening protocols, arguing the need for clear guidance in acute stroke clinical pathways on procedures for dysphagia screening.

May ultrasonography be considered a useful tool for bedside screening of dysphagia in patients with acute stroke? A cohort study.

Dysphagia is a primary risk factor for pneumonia and affects around 50% of acute stroke patients. Systematic bedside swallowing screening of acute stroke patients is recommended before oral intake. Currently there is lack of comprehensive dysphagia assessment tools with robust good accuracy, clinical utility and cost-effectiveness. An altered hyoid bone movement may represent a major risk factor for aspiration. Ultrasonography quantitatively measures hyoid-larynx approximation, which was found reduced in stroke patients with dysphagia. Although ultrasonography was suggested for assessing stroke patients with dysphagia, there is lack of evidence about the acute phase of stroke. Thus, our aim was to investigate the use of ultrasonography for bedside screening of dysphagia in acute stroke patients. Nineteen acute stroke patients were included. Each patient performed clinical bedside screening for dysphagia by means of the Gugging Swallow Screen and the Functional Oral Intake Scale. Furthermore, all patients underwent ultrasonography in order to measure the distance between the thyroid cartilage and hyoid bone during swallowing (water bolus of 3 mL). The hyoid-larynx approximation distance (obtained by subtracting [a-b] the shortest distance between the hyoid bone and thyroid cartilage during swallowing (b) from the initial resting distance (a) and degree {[(a-b)/a]×100} were calculated). The Functional Oral Intake Scale showed a significant direct association with the hyoid-larynx approximation distance (P=0.011) and degree (P=0.005). Also, the Gugging Swallow Screen showed a significant direct association with the hyoid-larynx approximation distance (P=0.008) and degree (P=0.004). The hyoid-larynx approximation distance and degree were significantly reduced in dysphagic patients. Our findings support the use of ultrasonography in aid of swallowing clinical (non-instrumental) evaluation for the bedside screening of dysphagia in acute stroke patients.

Abstract NS2: Effect of Volume-Viscosity Swallow Test (V-VST) in Acute Ischemic Stroke Patients With Dysphagia: A Hospital-Based Case-Control Study

Background: The dysphagia screening in acute ischemic stroke plays an important role in patients with risk of dysphagia. The aim of this hospital-based case-control study is to explore if V-VST, as a new nurse-driven dysphagia screening tool for AIS patients, might help to reduce the rate of post-stroke pneumonia and early withdraw of feeding tube. Methods: 1598 acute ischemic stroke patients were enrolled in this study. The standard protocol in AIS patients were assessed by WST (before intervention and plus with V-VST after intervention). The V-VST assessment were be trained in two senior nurses and all AIS patients were assessed by V-VST during July 1and Dec 30 th , 2017. Among 299 AIS patients with suspected, all clinical data were analyzed. The comparison of their rate of pneumonia in hospital and withdraw rate of tubefeeding before discharge were performed between patients post-intervention (January 1, 2018-June 30, 2019)and those admitted before the intervention (January 1, 2016-June 30, 2017). Results: The baseline characteristics of the pre- and post- intervention AIS groups were similar in age, gender, NIHSS. The implementation of V-VST have a statistically significant reducing the risk of pneumonia with an adjusted HR (0.60, 95% CI 0.43-0.84, P=0.003). Additionally, follow-up V-VST were likely to be associated the withdraw rate of tube-feeding at discharge (29/168 vs 38/131 P=0.016).There is also a trend of length of tube-feeding decreasing (8.32±12.27 vs 6.84±8.61 P=0.241). Conclusion: In our study, the V-VST is a feasible bedside tool. The implemental might be associated with the reduction of post-stroke pneumonia. Therefore, it meets the requirements of a clinical screening test for dysphagia in acute stroke patients at bedside. Large prospective interventional study is needed to confirm our findings. V-VST: Volume-viscosity Swallow Test WST: Water Swallow Test AIS: Acute Ischemic Stroke HR: hazard ratio

Adjustment of oral diet based on flexible endoscopic evaluation of swallowing (FEES) in acute stroke patients: a cross-sectional hospital-based registry study

BackgroundDiagnosing dysphagia in acute stroke patients is crucial, as this comorbidity determines morbidity and mortality; we therefore investigated the impact of flexible nasolaryngeal endoscopy (FEES) in acute stroke patients.MethodsThe FEES investigation as performed in acute stroke patients treated at a large university hospital, allocated as a standard procedure for all patients suspected of dysphagia. We correlated our findings with baseline data, disability status, pneumonia, duration of hospitalisation, necessity for mechanical ventilation and treatment on the intensive care unit. The study was designed as a cross-sectional hospital-based registry.ResultsWe investigated 152 patients. The median age was 73; 94 were male. Ischemic stroke was diagnosed in 125 patients (82.2%); 27 (17.8%) suffered intracerebral haemorrhage.Oropharyngeal dysphagia was diagnosed in 72.4% of the patients, and was associated with higher stroke severity on admission (median NIHSS 11 [IQR 6–17] vs. 7 [4–12], p = .013; median mRS 5 [IQR 4–5] vs. 4 [IQR 3–5], p = .012). Short-term mortality was higher among patients diagnosed with dysphagia (7.2% vs. 0%, p = .107). FEES examinations revealed that only 30.9% of the patients had an oral diet appropriate for their swallowing abilities.A change of oral diet was associated with a better outcome at discharge (mRS; p = .006), less need of mechanical ventilation (p = .028), shorter period of hospitalisation (p = .044), and lower rates of pneumonia (p = .007) and mortality (p = .011).ConclusionDue to the inability of clinical assessments to detect silent aspiration, FEES might be better suited to identify stroke patients at risk and may contribute to a better functional outcome and lower rates of pneumonia and mortality. Our findings also point to a low awareness of dysphagia, even in a specialised stroke centre.FEES in acute stroke patients helps to adjust the oral diet for the vast majority of stroke patients (69.1%) based on their swallowing abilities, potentially avoiding severe complications.

Lesion location and other predictive factors of dysphagia and its complications in acute stroke

Early detection of dysphagia is crucial in stroke patients as a result of increased morbidity and mortality due to malnutrition and respiratory tract infections. The aim of this study was to identify possible predictors of the onset of dysphagia following stroke in order to be able to act precociously. Observational, prospective study in which a Volume-Viscosity Swallow Test (V-VST) was carried out in the first 72h following admission to assess dysphagia in acute stroke patients with a previous result of <3 in the Eating Assessment Tool-10. Lesions were analysed by computed tomography and/or magnetic resonance, using the ABC/2 formula to calculate their volume. Likewise, 3-month follow-up was carried out for the evaluation of the occurrence of respiratory tract infections and deaths. Out of 106 patients admitted for acute stroke, 60 (56.60%) presented dysphagia (44.40% showing alterations in the effectiveness of swallowing and 33.30% in its safety). The factors that were related to dysphagia were: older age (76.40±11.50 vs 66.37±13.85 years, p=0.0001), stroke severity as measured on the National Institute of Health Stroke Scale (6.81±5.83 vs 3.38±3.46, p=0.001) and greater volume of the lesion (23.47±47.15 vs 7.50±14.53ml, p=0.042). The variables that were influenced by a greater lesion size were the presence of cough, oxygen desaturation and impaired labial seal. Dysphagia was not affected by the lateralization of the lesion or by the type of stroke (ischaemic/haemorrhagic). Despite the fact that 68.80% of the patients with a temporoparietal lesion presented dysphagia, no significant differences were observed regarding the location of the lesion in the regions studied. 27.3% of the patients with frontal lesions presented respiratory infections after discharge (p=0.018), a condition which was also observed in 20.0% of patients with dysphagia (p=0.044). Mortality during the 3-month follow-up period was 20.0% for patients with a positive V-VST (p=0.005), due to respiratory infection in 66.6% of the cases (p=0.0001). Post-stroke dysphagia was associated with the occurrence of respiratory tract infection and mortality. Our study also provides more information about how certain demographic and clinical factors, as well as neuroimaging patterns, influence dysphagia. This fact may help to identify at an early stage those patients with a greater risk of developing swallowing alterations.

Predicting Dysphagia with National Institute of Health Stroke Scale: Distinction between Infra- and Supratentorial Region is Essential

Background: For the early detection of post-stroke dysphagia (PSD), valid screening parameters are crucial as part of a step-wise diagnostic procedure. This study examines the role of the National Institute of Health Stroke Scale (NIH-SS) as a potential low-threshold screening parameter. Methods: During a ten-year period, 687 newly admitted patients at University Hospital Muenster were included in a retrospective analysis, if they had ischemic or haemorrhagic stroke confirmed by neuroimaging and had received NIH-SS scoring and endoscopic swallowing evaluation upon admission. The NIH-SS score was correlated with dysphagia severity as measured by the validated 6-point fiberoptic endoscopic dysphagia severity score (FEDSS), and the ideal cut-off score to predict PSD, defined as FEDSS > 1, was calculated. Supra- and infratentorial strokes were analysed separately due to their differing role in the pathophysiology of neurogenic dysphagia. Results: NIH-SS and dysphagia severity show a significant positive correlation in the whole study population (R² = 0.745) as well as in both analysed subgroups (R² = 0.494 for supra- and R² = 0.646 for infratentorial strokes, p < 0.0005, respectively). For supratentorial strokes, the ideal NIH-SS cut-off is > 9 (sensitivity 68.3%, specificity 61.5%, positive predictive value 89.7%, negative predictive value 28.4%). For infratentorial strokes, a lower ideal cut-off > 5 was calculated (sensitivity 67.4%, specificity 85.0%, positive predictive value 95.1%, negative predictive value 37.8%). Conclusions: NIH-SS may be used as an adjunct to predict dysphagia in acute stroke patients with moderate sensitivity and specificity. Differentiation between supra- and infratentorial regions is essential not to miss dysphagia in infratentorial stroke.

HUBUNGAN PELAKSANAAN SCREENING TEST MENELAN DENGAN KEJADIAN DISFAGIA PADA PASIEN BARU YANG MENDERITA STROKE AKUT

According to the NINDS 2015, States that a stroke occurs when the blood supply to brain fails suddenly interrupted due to a blockage or rupture of blood vessels were. Basic Health Research results that show an increase in the prevalence of stroke symptoms in Indonesia increased from 8.3 at 1000 in 2007 to 12.1 and at 1000 in 2013. One of the problems that arise due to stroke is a disorder of swallowing or dysphagia. According to the World Stroke Academy Learning Moduls in 2012 the prevalence of dysphagia in stroke sufferers range from 36 to 67%. In the year 2016 in RSSN dysphagia in stroke patients 22,94%. For early detection of dysphagia screening test required to swallow as a first step in identifying the risks due to dysphagia and aspiration in stroke patients. The purpose of this research is to know the relationship of the implementation of the screening test to swallow with dysphagia in acute stroke patients in the room just entered inpatient Neurology RSSN Bukittinggi in 2017. This research method using analytic, descriptive, then the data was processed using the Chi Square test. The sample in this study as many as 54 people respondents. Test result statistics retrieved value p value = 0.002 (p &lt; α) then it can be inferred the existence of a relationship between the implementation of the screening test to swallow with dysphagia in acute stroke patients the new entry. Analysis of the results obtained OR = 9.281 meaning respondents who perform screening test procedures in accordance with the swallow has a chance of 9.281 times in detecting the occurrence of dysphagia. Suggestions in this study is the implementation of a screening test this swallow can be included in SPO for nurses in Bukittinggi in the room especially RSSN Neurology in detecting the onset of dysphagia in acute stroke patients.

Assessment of Dysphagia in Acute Stroke Patients by the Gugging Swallowing screen

Assessment of Dysphagia in Acute Stroke Patients by the Gugging Swallowing screen

The sensitivity and specificity of the Chinese eating assessment tool (EAT-10) for screening oropharyngeal dysphagia in acute stroke patients

Objective To study the sensitivity and specificity of the Chinese eating assessment tool (EAT-10) in screening acute stroke patients for oropharyngeal dysphagia (OD). Methods A total of 130 inpatients with acute stroke were screened using the Chinese EAT-10. On the same day they were also screened using the gold stan-dard technique for diagnosing dysphasia—videofluoroscopy. A receiver operating characteristics (ROC) curve was developed to study EAT-10′s sensitivity and specificity. A Youden index, positive predictive value (PPV), negative predictive value (NPV), and positive and negative likelihood ratios (LHR+ and LHR-) were quantified. Results According to the ROC curve, a cut-off point of 1 (EAT-10 score≥1) gave the best sensitivity (77.9%), the highest NPV (73.2%), with 66.1% specificity, 71.6% PPV, 2.30 LHR+ and 0.33 LHR- in screening for OD. The test-retest reliability was above 0.7. An investigator consistency reliability test showed good repeatability, and the consistency between each item and the mean total score was high. Conclusion The Chinese EAT-10 has good test-retest reliability and investigator consistency. The optimal cut-off point is 1, with good sensitivity and NPV at scores≥1. The test can be recommended as a screening tool for OD in acute stroke patients. Key words: Chinese eating assessment tool; Stroke; Oropharyngeal dysphagia; Dysphagia

Abstract WP398: Nursing Swallow Screen Validated for Detection of Dysphagia in Acute Stroke Patients

Background: The importance of screening for dysphagia in stroke patients is well established, yet an optimal tool has not been identified. The CCW (cough on command, control of saliva and water swallow) Swallow Screen builds on existing data for item selection. Purpose: The purpose of the study was to compare the CCW Swallow Screen against the Gold Standard speech language pathology (SLP) swallow evaluation for detection of dysphagia in acute stroke patients. Methods: Using the CCW Swallow Screen and SLP swallow evaluation outcome measures, a prospective correlation study was performed on a sample of 88 acute stroke patients (SEM = 1.63). Inclusion required passing the CCW pre-screen component: be alert, follow commands and sit up. SLP swallow evaluation was completed within 3 hours after the nurse administered CCW screen, to support criterion-related validity. Data analysis included sensitivity and specificity, and positive (+LR) and negative (-LR) likelihood ratios. Specific statistics generated included chi-square (χ2), correlation (Phi ≥ .80). Inter-rater reliability (IRR) was supported by prior training, testing and competency validation of nurses, plus performance monitoring during data collection. IRR was computed with Cohen’s kappa. Results: The CCW Swallow Screen correctly detected the presence and absence of dysphagia, (Sensitivity = 84%; Specificity = 95%) and demonstrated a strong certainty that dysphagia was present or not present (+LR = 16.8; -LR = 0.17). A statistically significant association between the CCW Swallow Screen and the SLP evaluation (χ2 (1) = 56.66, p &lt; .001) indicated that the CCW Swallow Screen and the SLP evaluation equally measured dysphagia in this stroke sample. The association between the two tests was found to be strong (Phi = .80). IRR results revealed zero variance as both raters observed and passed all nurses in perfect agreement (IRR = 1) for competency validation and data collection observation. Conclusion: The CCW Swallow Screen is a reliable, valid tool for detection of dysphagia in acute stroke patients. The simplicity of the tool supports feasibility in a variety of clinical settings. Further validation with a similar sample is warranted.

Nursing management of post-stroke dysphagia in a tertiary hospital: a best practice implementation project.

Dysphagia, or difficulty in swallowing, is a serious and life-threatening medical condition that affects a significant number of individuals with acute neurological conditions such as stroke. Nurses, who are available to patients 24 hours a day in hospital are in an ideal position to identify individuals with swallowing difficulties and initiate interventions that may prevent further complications until a formal assessment can be undertaken. The aim of this evidence implementation project was to improve nursing management of dysphagia in acute stroke patients and prevent the occurrence of aspiration in patients admitted to the neurology ward of Huashan Hospital, Fudan University, Shanghai. This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tools. The same six audit criteria were used for the baseline and the follow-up clinical audits. The baseline audit was followed by the implementation of strategies targeted to address the identified barriers and the follow-up audit evaluated changes in practice. The same sample size (20 nurses and 30 patients) was used for both audits. Improvements in practice were observed for all six audit criteria. The result of the post-implementation audit showed 100% compliance for the following recommendations: use of a validated tool, nurse-initiated dysphagia screening, appropriate referral to Speech and Language Therapy and education for nurses on dysphagia screening. The lowest compliance rate was for criterion 4 (patient education before discharge), which was 80%. The compliance rate for criterion 3 (screening within 24 hours from admission) was 93%. This project has demonstrated significant improvements in nursing practice related to dysphagia screening and management. The project was successful not only in increasing the knowledge and skills of nurses but also in implementing a formalized process for dysphagia screening and referral. Strategies to sustain practice change should be developed, and regular audit cycles need to be carried out to monitor the process and evaluate outcomes.

Abstract 28: A Nursing Swallow Screen is Better Than the National Institutes of Health Stroke Scale at Predicting Dysphagia

Introduction: The Joint Commission recommends all acute stroke patients undergo swallow screening prior to any oral intake to decrease risk of aspiration pneumonia. In a 2009 study, a nursing swallow screening tool was compared to the National Institutes of Health Stroke Scale (NIHSS) to identify dysphagia in acute stroke patients. They found the NIHSS was a better predictor for identifying dysphagia. This IRB-approved study replicated and expanded the 2009 study in a community hospital with stroke patients using a facility-based nursing Stroke Swallow Screen (SSS). Hypothesis: The investigators hypothesized that the results would corroborate the 2009 study for the purpose of streamlining acute stroke assessment in the Emergency Department (ED). Methods: SSS results, NIHSS scores and speech-language pathology (SLP) swallowing evaluations of adult ischemic and hemorrhagic stroke patients were collected retrospectively via medical chart review. SSS results and NIHSS scores were compared against the “gold standard” for dysphagia diagnosis, the SLP evaluation. Convenience sampling, based on diagnosis within a 24-month time interval, determined the study sample. Results: Dysphagia prevalence among subjects (N=240) was 45%. The SSS demonstrated 95.4% sensitivity compared to 80.6% for the NIHSS. Conclusion: The SSS was a better predictor for presence of dysphagia in acute stroke patients than the NIHSS. Our findings stand in contrast to the 2009 report, in which dysphagia sensitivities of their screening tool and the NIHSS were 29% and 79%, respectively. Therefore, streamlining these ED stroke assessments would not be efficacious in our facility.

A prospective study into the incidence of aspiration and dysphagia in acute stroke patients admitted to Beaumont Hospital

Stroke is the second leading cause of death in the world [1]; 1.3-5% of these deaths are caused by aspiration pneumonia [2]. Dysphagia occurs in 50% of stroke cases; 60% of these cases can lead to silent aspiration [3]. This study aims to assess the incidence of aspiration and dysphagia in the Beaumont Hospital Acute Stroke Unit (BHASU), while discussing the use of the Beaumont Hospital Swallow Screen (BHSS) and subsequent investigations, involving fiberoptic endoscopic evaluations of swallowing (FEEs) and videofluoroscopy.

Article 6 Neuromuscular Electrical Stimulation Efficacy in Acute Stroke Tube Dependent Dysphagia

Comparing efficacy of Neuromuscular Electrical Stimulation (NMES) with Progressive Resistance Therapy (PRT) to Traditional Dysphagia Therapy (TDT) for treatment of feeding tube dependent dysphagia in acute stroke patients during inpatient rehabilitation.