Dysphagia Screening Research Articles

Contributing Factors of Dysphagia in Indonesian Elderly

Abstract Objective Dysphagia is one of the signs that can describe oral hypofunction in the elderly. This condition is usually not noticed nor realized by the elderly and their families, resulting in disability and death. Studies on the relationship between age, gender, education, the number of systemic diseases, and the number of remaining teeth toward dysphagia in the elderly are still limited, so further research is needed. The aim of this study was to analyze the relationship between age, sex, education level, the number of systemic diseases, and the number of remaining teeth with dysphagia and find out which factors contribute the most to dysphagia. The contributing factors need to be known to minimize the risk of dysphagia. Materials and Methods This is a cross-sectional study with 121 elderly aged 60 years living in community dwellings as subjects of this study. General health data were obtained from anamnesis; demographic data were also collected and an examination of the number of remaining teeth was carried out and recorded on the odontogram by one researcher. After that, a dysphagia screening tool was given for self-assessment or assisted by the two researchers according to the conditions felt. Two researchers were calibrated before collecting data. Results In the bivariate analysis, age, the number of remaining teeth, and several systemic diseases were associated with dysphagia (p = 0.027, 0.023, and 0.047, respectively). No association was found between gender, education, and dysphagia status (p > 0.05). Age (p = 0.027), gender (p = 0.165), number of remaining teeth (p = 0.023), and the number of systemic diseases (p = 0.047) are the risk factors that were included in the multivariate model. From the final multivariate model, the number of remaining teeth (p = 0.017; odds ratio [OR] = 4.318), several systemic diseases (p = 0.036; OR = 2.427), and age (p = 0.072; OR = 1.962) contributed most to the dysphagia status, after controlling for confounding variables. Conclusion It is concluded that the number of remaining teeth, several systemic diseases, and age are the factors that contribute the most to the occurrence of dysphagia.

Dysphagia screening among stroke patients in a tertiary hospital: a best practice implementation project.

The study aimed to promote nurses' compliance with best practices for dysphagia screening in patients with stroke. Dysphagia can significantly increase the risk of complications, especially aspiration pneumonia, leading to increased risk of disability, death, and high medical expenses. Dysphagia screening can reduce aspiration risk and is recommended as a crucial step in dysphagia management; however, not all patients with stroke undergo dysphagia screening in the neurology ward. The JBI Evidence Implementation Framework was used in this study. A baseline audit was conducted by interviewing 22 nurses and reviewing 48 medical records to evaluate current practice against best practice recommendations. The JBI Getting Research into Practice (GRiP) tool was used to identify barriers and strategies for practice change. A follow-up audit of 19 nurses and 48 medical records was conducted after implementation of improvement strategies. The follow-up audit results showed improvement in three criteria compared with the baseline audit: for Criterion 1, compliance increased by 27.3%, rising from 72.7% to 100%; for Criteria 3 and 4, compliance increased by 77.1%, rising from 20.8% to 97.9%. The difference in nurses' knowledge, attitude, and behavior scores for dysphagia screening between the baseline and follow-up audits was statistically significant (all p < 0.05). The project showed improvements in evidence-based practice in the dysphagia screening of stroke patients in a neurology ward. However, more work needs to be done to ensure the sustainability of best practices, such as regular training for nurses, supervision from managers, and regular audits of dysphagia screening.

The Arabic EAT-10 and FEES in dysphagia screening among cancer patients: a comparative prospective study.

Head and neck cancer treatments, such as radiotherapy, chemotherapy, and surgery, have diverse effects on patients, leading to dysphagia as a significant post-treatment issue. This study aims to evaluate the effectiveness of the Arabic version of the EAT-10 screening instrument (A-EAT-10) using Fiber-Optic Endoscopic Evaluation of Swallowing (FEES) as an imperfect gold standard. Additionally, we seek to establish a correlation between A-EAT-10 and PEG tube insertion in head and neck cancer (HNC) patients. Our sample comprised 130 head and neck cancer patients with varying cancer types at King Hussein Cancer Center (KHCC). We followed these patients throughout their distinct treatment plans up to one month after their final treatment session. During follow-up visits, we administered the A-Eat-10 instrument to monitor dysphagia. FEES were conducted at the initial and concluding visits to compare results with A-EAT-10 scores. The results in our tests, assuming independence or dependence, demonstrated excellent agreement. A-EAT-10 exhibited outstanding predictive capabilities with an AUC ranging from 93 to 97%. A-EAT-10 tended to slightly overestimate dysphagia at later treatment stages by approximately 20% compared to FEES, with an RR of 1.2 (95% CI 0.91, 1.56, p-value = 0.21), indicating statistical insignificance. In conclusion, A-EAT-10 is an excellent option for dysphagia evaluation, offering non-invasive, straightforward, and cost-effective advantages compared to FEES. Its utility extends to predicting the need for PEG tube insertion at initial patient visits, making it a valuable tool for informed treatment decisions. Notably, A-EAT-10 demonstrates a diminishing correlation with FEES over time.

Dysphagia in neuromyelitis optica spectrum disorder and multiple sclerosis: A comparison of frequency, severity, and effects on quality of life

OverviewDysphagia has been previously discussed as a potential life-threatening condition secondary to chronic neurological diseases such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). However, its impact on the quality of life (QoL) of patients with NMOSD has never been studied before. This study aims to determine the frequency of dysphagia and its impact on QoL in NMOSD patients in comparison with MS people and healthy individuals. MethodsSeventy-five MS and sixty-five NMOSD patients with an expanded disability status scale (EDSS) score ≥ 3.5 in addition to 106 healthy controls were enrolled in this cross-sectional study. All the participants completed the self-report dysphagia in MS (DYMUS) and 36-item short-form health survey (SF-36) questionnaires. In case of positive answers to at least one of the questions in DYMUS, they were asked to fill out the dysphagia handicap index (DHI) questionnaire. ResultsThe frequency of dysphagia in NMOSD, MS, and control groups was 61.54 %, 72.97 %, and 27 %, respectively. Patients with swallowing problems had reduced scores across different swallowing-related QoL domains compared to non-dysphagic patients (p < 0.05). NMOSD (1, IQR [0–3.5]) and MS patients (2, IQR [0–4]) had a significantly higher median total DYMUS score than control (0, IQR [0–1]) (p < 0.01). However, there was no discernible difference between the two patient groups. NMOSD had the highest mean total DHI score (21.22 ± 21), followed by MS (15.25 ± 18.94) and control (7.08 ± 5.12). A significant correlation was seen in the NMOSD group between the DHI total score and the SF-36 total score (r = 0.62, p < 0.05). The DHI and SF-36 subscales showed a strong association as well. The overall SF-36 scores in both the control and MS groups was not significantly correlated with DHI. The generalized linear model analysis showed that the NMOSD group's age (p-value = 0.005), EDSS (p-value < 0.001), and total DYMUS score (p-value = 0.018) significantly affected overall health status. ConclusionThe presence of dysphagia significantly impacts the QoL in NMOSD patients, particularly in aspects related to swallowing. These findings underscore the critical need for diligent dysphagia screening and emphasize the importance of educating both caregivers and NMOSD patients about managing this challenging symptom.

Perspective on dysphagia screening, assessment methods, and protocols in intensive care units: an opinion article.

Perspective on dysphagia screening, assessment methods, and protocols in intensive care units: an opinion article.

Validity and Reliability of the Turkish Version of the Postextubation Dysphagia Screening Tool.

Background and Purpose: Patients who have been intubated ≥48 hours are at risk of dysphagia. Evaluation of swallowing before starting oral feeding after extubation is necessary to prevent aspiration and the problems caused by aspiration. The Postextubation Dysphagia Screening tool is a validated and reliable tool used to evaluate extubation-induced dysphagia. This study was conducted to evaluate the validity and reliability of the Postextubation Dysphagia Screening Tool for the Turkish population. Methods: The study had a methodological design and was carried out with 50 patients followed in the intensive care unit of a public hospital. The study was carried out in four stages: (1) language validity, (2) content validity, (3) establishing interrater reliability by agreement with two observers (intensive care nurse and intensivist), and (4) establishing sensitivity and specificity with the intensive care nurse and intensivist. Results: The overall content validity index was 0.91, indicating content validity. Interrater reliability was established (Cohen's g = 0.93). The prevalence of postextubation dysphagia was 42%, and the sensitivity of the Postextubation Dysphagia Screening Tool was 82% and the specificity was 64%. Implications for Practice: The Turkish version of the Postextubation Dysphagia Screening Tool exhibited good evidence of validity and reliability and was determined important as it can help nurses evaluate postextubation dysphagia in intensive care patients. The use of this tool by a nurse reduces the risk of unsafe oral intake among patients after prolonged intubation. This tool allows accurate assessment of dysphagia and initiation of early and safe oral feeding in critical care patients.

Prediction of dysphagia aspiration through machine learning-based analysis of patients’ postprandial voices

BackgroundConventional diagnostic methods for dysphagia have limitations such as long wait times, radiation risks, and restricted evaluation. Therefore, voice-based diagnostic and monitoring technologies are required to overcome these limitations. Based on our hypothesis regarding the impact of weakened muscle strength and the presence of aspiration on vocal characteristics, this single-center, prospective study aimed to develop a machine-learning algorithm for predicting dysphagia status (normal, and aspiration) by analyzing postprandial voice limiting intake to 3 cc.MethodsConducted from September 2021 to February 2023 at Seoul National University Bundang Hospital, this single center, prospective cohort study included 198 participants aged 40 or older, with 128 without suspected dysphagia and 70 with dysphagia-aspiration. Voice data from participants were collected and used to develop dysphagia prediction models using the Multi-Layer Perceptron (MLP) with MobileNet V3. Male-only, female-only, and combined models were constructed using 10-fold cross-validation. Through the inference process, we established a model capable of probabilistically categorizing a new patient's voice as either normal or indicating the possibility of aspiration.ResultsThe pre-trained models (mn40_as and mn30_as) exhibited superior performance compared to the non-pre-trained models (mn4.0 and mn3.0). Overall, the best-performing model, mn30_as, which is a pre-trained model, demonstrated an average AUC across 10 folds as follows: combined model 0.8361 (95% CI 0.7667–0.9056; max 0.9541), male model 0.8010 (95% CI 0.6589–0.9432; max 1.000), and female model 0.7572 (95% CI 0.6578–0.8567; max 0.9779). However, for the female model, a slightly higher result was observed with the mn4.0, which scored 0.7679 (95% CI 0.6426–0.8931; max 0.9722). Additionally, the other models (pre-trained; mn40_as, non-pre-trained; mn4.0 and mn3.0) also achieved performance above 0.7 in most cases, and the highest fold-level performance for most models was approximately around 0.9. The ‘mn’ in model names refers to MobileNet and the following number indicates the ‘width_mult’ parameter.ConclusionsIn this study, we used mel-spectrogram analysis and a MobileNetV3 model for predicting dysphagia aspiration. Our research highlights voice analysis potential in dysphagia screening, diagnosis, and monitoring, aiming for non-invasive safer, and more effective interventions.Trial registration: This study was approved by the IRB (No. B-2109-707-303) and registered on clinicaltrials.gov (ID: NCT05149976).

Exploring the diagnostic accuracy and applicability of the Gugging Swallowing Screen in children with feeding and/or swallowing disorders.

The Gugging Swallowing Screen (GUSS) is a bedside dysphagia screening tool that has been designed to determine the risk of aspiration in acute stroke patients. There is no evidence in the literature for the GUSS for the pediatric population. The present study aimed to determine the diagnostic accuracy of GUSS as a screening tool in the Greek language for children with dysphagia. Eighty-Greek-Cypriot children aged 3-12 years who had dysphagia participated in this retrospective study. The translated into Greek GUSS was administered twice (pre- and post-therapy) to each patient throughout 24 sessions of dysphagia therapy. The GUSS showed a high internal consistency (Cronbach's α = 0.826), good test-retest reliability (rs = 0.767), convergent validity compared to the Greek Pediatric Eating Assessment tool-10 (PEDI-EAT-10) total score (rs = -0.365), and inter-rater reliability (κ = 0.863). A total cutoff points equal to 13.00 was also calculated. Aspiration was identified by the GUSS with low sensitivity and high specificity (PPV 100%, NPV 57%, LR+ NA, LR- 0.79); dysphagia/penetration was identified with high sensitivity and low specificity (PPV 33%, NPV 100%, LR+ 0.102, LR- NA). The pediatric version of GUSS has been found to be a valuable tool in identifying the risk of aspiration as that of adults. It proved to be used as a good screening guide for selecting and confirming the existence of dysphagia from instrumental assessments. This is the first study of the pediatric version of GUSS, and future studies on this topic are needed.

Screening performance of a 100-mL water swallowing test in community-dwelling older adults: A receiver operating characteristic analysis.

The development of a dysphagia screening test is an urgent issue in the field of frailty prevention among community-dwelling older people. The purpose of this study was to evaluate the screening performance of a 100-mL water swallowing test (WST). The study employed a cross-sectional design. Participants were 304 (65 men and 239 women, mean age = 80 years) Japanese community-dwelling older adults aged over 65 years. We investigated swallowing disorder using the 10-item Eating Assessment Tool (EAT-10), and compared choking signs, swallowing time and number of swallows, and their combination in the 100-mL WST. We calculated the sensitivity and specificity of these indices. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off value of swallowing time and number of swallows in the 100-mL WST based on the Youden Index among participants without choking signs. The sensitivity and specificity of choking signs in the 100-mL WST were 20% and 91%, respectively. The discriminating ability of swallowing time and number of swallows among participants without any choking signs was .76 and .72, respectively, in the area under the ROC curve. Diagnostic sensitivity and specificity to discriminate dysphagia from normal swallowing ability were 65% and 74% when the cut-off was >10 s based on maximisation of the Youden Index. The 100-mL WST performed best when the indices of choking signs and swallowing time were combined, with a sensitivity and specificity of 72% and 68%, respectively. The 100-mL WST would be an adequate screening tool when compared to the EAT-10.

Transient postictal dysphagia in older adults with focal structural epilepsy.

Seizures can cause transient neurological symptoms, such as hemiparesis and aphasia. However, temporary swallowing changes leading to postictal dysphagia have not been previously described. Therefore, this study evaluated the presence of swallowing disorders following seizure. In addition, dysphagia severity and duration of any recovery from dysphagic symptoms were investigated. The local clinical database of all fiberoptic endoscopic evaluation of swallowing (FEES) examinations performed from 2008 to 2019 was screened for patients diagnosed with seizures, but excluding patients with intensive care unit admission or intubation >24 h. Patient charts were evaluated to identify preexisting dysphagia or potential concurrent medical causes for dysphagia, including hyponatremia, increased intracranial pressure, sepsis, or other encephalopathies associated with infections, or other possible causes at the time of admission. Patients receiving >.5 defined daily doses of benzodiazepines or neuroleptics were also excluded. Age, sex, seizure semiology and etiology, comorbidities, concurrent pneumonia, and dysphagia course during hospitalization were evaluated as predictors of the occurrence of dysphagia or its potential duration. We identified 41 patients with dysphagia following a seizure, without evidence of any concurrent cause of swallowing dysfunction. These patients all presented with focal structural epilepsy, they had a mean age of 79 ± 11.3 years (range = 44-95 years), and 21 were women. The mean Elixhauser Comorbidity Score was 4.8. Hospital-acquired pneumonia was detected in 21 patients (51.2%). FEES diagnosed mild and severe dysphagia in 21 (51.2%) and 20 (48.8%) patients, respectively. Dysphagia improved significantly (p = .001) during hospitalization, persisting for an average of 3.9 days (median = 3 days, SD = 2.07 days, range = 1-8 days). Dysphagia is a potential transient neurological deficit following seizure. Our findings suggest that older patients, with focal structural epilepsy, are at risk for postictal dysphagia. Further studies are needed to ascertain the prevalence, complications, and predictors of postictal dysphagia. Dysphagia screening may improve early detection in patients with relevant risk factors, as well as reduce the occurrence of aspiration pneumonia.

Diagnostic value of water swallow test for dysphagia in patients with head and neck cancer: A systematic review and meta-analysis.

The diagnostic efficacy of the water swallow test (WST) is relatively robust for patients with neurogenic dysphagia; however, its diagnostic performance in identifying dysphagia among patients with HNC varies across studies. Our study aims to assess the diagnostic value of the WST for detecting dysphagia in patients with HNC. Systematic retrieval of studies on the use of WST for screening dysphagia in patients with HNC from databases up to August 1, 2023. Quality assessment of the included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the screening ability of WST for dysphagia. A total of seven articles, encompassing eight study groups, were included, involving the analysis of 691 patients. The meta-analysis results demonstrate that the WST has a combined sensitivity, specificity, positive LR, negative LR, DOR, and AUC for diagnosing dysphagia in patients with HNC of 0.82 (95% CI [0.64, 0.92]), 0.79 (95% CI [0.70, 0.86]), 4.00 (95% CI [2.51, 6.36]), 0.22 (95% CI [0.10, 0.50]), 17.94 (95% CI [5.56, 57.92]), and 0.86 (95% CI [0.83, 0.89]), respectively. Significant heterogeneity was observed among the included studies. Meta-regression analysis showed that the pooled sensitivity of tumor sites and treatment was closely related, while the pooled specificity of treatment and version was closely related. The subgroup analysis showed that the WST's pooled sensitivity for diagnosing dysphagia in patients with nasopharyngeal cancer was 0.40 (95% CI [0.26, 0.56]), with an AUC of 0.50, lower than in other HNC sites. The WST performed better in surgical patients than in those undergoing radiotherapy (RT) or chemoradiotherapy (CRT), with lower sensitivity, specificity, and AUC values of 0.49 (95% CI [0.36, 0.61]), 0.66 (95% CI [0.59, 0.72]), and 0.64, respectively, for RT or CRT patients. The modified WST version showed different specificity values of 0.82 (95% CI [0.75, 0.87]), compared to the regular version of 0.68 (95% CI [0.61, 0.74]). Additionally, Deek's test indicated the absence of publication bias in this study (p = 0.32). The WST demonstrates favorable sensitivity and specificity in detecting dysphagia among patients with HNC. However, the diagnostic value may vary depending on factors such as tumor sites, treatment, and the specific version of the WST used.

Prevalence of Dysphagia and Risk of Malnutrition in Elderly Living in Nursing Homes.

Swallowing difficulties commonly co-occur with malnutrition in the elderly. However, there is no consensus on which assessment tools to use, and thus reported prevalence varies. The aim of this study was to survey the prevalence of dysphagia and risk of malnutrition in elderly people in nursing homes, evaluate the possible associations between swallowing function and malnutrition and survey whether there were associations between self-perceived function and the results of a screening of dysphagia. A total of 35 residents (aged 67-100years old) without serious cognitive impairment in the general wards of two nursing homes in Gothenburg were investigated. Swallowing ability was assessed with the Gugging Swallowing Screen (GUSS) test, self-rated swallowing ability with the 4QT and the Swedish Eating Assessment Tool-10 (S-EAT-10) and risk of malnutrition with the Minimal Eating Observation and Nutrition Form-Version 2 (MEONF-II). Eleven participants (31.4%) exhibited dysphagia according to the GUSS and 10 participants (29.4%) showed moderate or high risk of malnutrition. In total 16 (46%) participants reported abnormal swallowing on 4QT and 14 (40%) participants reported abnormal swallowing on S-EAT-10. However, less than half of these had dysphagia according to the GUSS. No association was found between swallowing ability measured by the GUSS and risk of malnutrition, although a tendency towards a weak association was noted, or self-rated swallowing ability measured by the 4QT and S-EAT-10. The study found that approximately one-third of the tested participants presented with signs of dysphagia as measured with the screening instrument GUSS, even though only a few were known to have any difficulties prior to testing. This highlights that dysphagia is probably more prevalent than patients themselves and caregivers are aware of, thus, screening is of importance, to enable safer nutritional intake.

Incidence and factors associated with dysphagia in intensive care unit patients 24 h after extubation.

Post-extubation dysphagia deserves attention because it places patients at risk following extubation, especially critically ill patients in intensive care unit. However, there are limited studies of post-extubation dysphagia in the early stages after extubation. To investigate the incidence and factors associated with post-extubation dysphagia among patients in intensive care unit within 24 h of extubation. A prospective descriptive study was carried out with 173 adult patients in intensive care unit with tracheal extubation at a tertiary hospital in Guangzhou, China. The Gugging Swallowing Screen was used to evaluate the swallowing function of patients 1, 4 and 24 h after extubation. Demographic and clinical data were retrieved from medical records. The incidence of post-extubation dysphagia in patients within 1, 4 and 24 h after extubation was 86.71% (n = 150), 63.01% (n = 109) and 43.35% (n = 75), respectively. The risk factors included older age (OR = 1.057, 95%CI [1.039, 1.072], p < .001), cardiovascular disease (OR = 0.098, 95%CI [0.082, 0.127], p = .012), thyroid dysfunction (OR = 5.042, 95%CI [1.527, 13.684], p < .001), non-post-operative admission (OR = 3.186, 95%CI [1.142, 14.422], p = .036), mechanical ventilation duration >48 h (OR = 3.558, 95%CI [1.217, 10.385], p = .020), intubation duration >24 h (OR = 0.533, 95%CI [0.278, 0.898], p = .048) and intubation model size ≤7 (OR = 0.327, 95%CI [0.158, 0.788], p < .01). This study revealed a high incidence of post-extubation dysphagia in critical patients in the 24 h after extubation, with the incidence decreasing over time. Screening of early post-extubation dysphagia after extubation is needed, but the specific evaluation time point requires further investigation. Patients with older age, cerebrovascular disease, thyroid dysfunction, post-operative admission, longer mechanical ventilation time, thicker intubation models and longer intubation time have a higher risk of the occurrence of post-extubation dysphagia. The incidence of post-extubation dysphagia is very high in the early stage. Within 24 h after extubation, the patient's swallowing function should be actively evaluated, and the occurrence of aspiration should be vigilant. Patients with older age, cerebrovascular disease, thyroid dysfunction, post-operative admission, longer mechanical ventilation time, thicker intubation models and longer intubation time should receive more attention.

External quality monitoring facilitates improvement in already well-performing stroke units: insights from RES-Q Poland.

The Registry of Stroke Care Quality (RES-Q) is used in Poland for quality monitoring by numerous hospitals participating in the Angels Initiative. Our aim was to assess the degree of improvement in highly stroke-oriented centres that report cases to the RES-Q each year. This retrospective analysis included Polish stroke units that from January 2017 to December 2020 contributed to the RES-Q at least 25 patients annually. Seventeen out of 180 Polish stroke units reported patients each year (2017, n = 1,691; 2018, n = 2,986; 2019, n = 3,750; 2020, n = 3,975). The percentage of ischaemic stroke patients treated with alteplase remained stable (26%, 29%, 30% and 28%, respectively). The door-to-needle time progressively decreased, from a median 49 minutes to 32 minutes. The percentage of patients treated ≤ 60 minutes and ≤ 45 minutes significantly increased (from 68% to 86% and from 43% to 70%, respectively), with no change observed between 2019 and 2020. Despite a general improvement in dysphagia screening (81%, 91%, 98% and 99%), screening performed within the first 24h from admission became less frequent (78%, 76%, 69% and 65%). In-hospital mortality significantly increased (11%, 11%, 13% and 15%), while the proportion of patients discharged home remained stable. Quality-oriented projects facilitate the improvement of stroke care, even in centres demonstrating good baseline performance. Polish stroke units that consistently reported cases to the RES-Q demonstrated improvement in terms of door-to- -needle time and dysphagia screening. However, there is still a need to shorten the time to dysphagia screening, and carefully monitor stroke unit mortality following the COVID-19 pandemic.

The 100ml-Timed Water Swallow Test: Pilot Data from Children with No Dysphagia.

Dysphagia screening tests are useful in identifying possible dysphagia for further evaluation and in supporting feeding recommendations. This study aimed to investigate swallowing parameters in children, while widening the pool of data available, using the '100ml-Timed Water Swallow Test' (100ml-TWST). Sixty Singaporean children aged 4 to 18years old completed the 100ml-TWST via a cup and a straw. Task completion, presence of cough, choke or throat clear, post-swallow voice quality, total time taken and number of swallows were observed. Subsequently, analysis of time per swallow (T/S), volume per swallow (V/S) and volume per time or swallowing capacity (V/T) were performed. Higher tendencies for coughing and task incompletion were observed in younger participants. A shorter time taken, fewer number of swallows, greater V/S and greater swallowing capacity were observed for adolescent or male participants, or via the mode of cup drinking. These could be due to oropharyngeal structural changes and swallow maturation with age, an increased capacity of oropharyngeal structures for swallowing in adolescent males, and more controlled or paced drinking from a straw. A plateau in time taken, number of swallows and swallowing capacity in adolescence were also observed, possibly indicating an emerging maturation of swallow functions during that period. Interestingly, speed of bolus movement was largely unaffected by age, gender and mode of drinking. Pilot data for children with no dysphagia have been established, while gaining insight into the swallowing parameters and maturation process in the paediatric population.

Abstract TP55: A Statewide Quality Improvement Project: Identifying Disparities in Dysphagia Screening for Stroke Patients

Objectives: One of the principal cornerstones of the Minnesota Department of Health’s Stroke Program is quality improvement. Minnesota Primary (PSC) and Comprehensive Stroke Center (CSC) hospitals have consistently demonstrated performance below the national benchmark (76%) for dysphagia screening. We formed a workgroup comprised of stroke coordinators from across the Minnesota Stroke System to stratify the data by race, ethnicity, and insurance status and collectively identify ways to improve dysphagia screening for stroke patients. Methods: In 2021, MN Stroke Registry data was analyzed for dysphagia screening performance and compliance. Data was stratified by race, ethnicity and insurance status to assess for variance in performance. Disparities by patient race/ethnicity and an overall underperformance on this measure in MN compared to hospitals nationwide was identified. Work group members developed an action plan to improve resources and increase dysphagia screening performance. Results: In Minnesota, Asian (63%) and African American (68%) stroke patients are less likely to be screened for dysphagia than stroke patients overall (76%). Patients on Medicaid were also slightly less likely to receive dysphagia screening. Statewide initiatives included: guidance on stratifying site-specific data; creation of Impaired Swallowing Education for medical providers accessible on YouTube, cultural considerations, and electronic health record best practices; facilitators and barriers were reported and shared. Conclusions: The overall percentage of dysphagia screening compliance has remained steady at 77%. Continuation of the QI project will focus on identifying group participants that are actively engaged and implementing programmatic changes to improve dysphagia screening and identify disparities within their organizations. Education was successfully disseminated to 136 hospitals across the Minnesota Stroke System with over 450 views on YouTube. The work group is exploring further development of data disaggregation standards, specific to the diverse and growing populations of Minnesota. This is a vital step to develop more effective strategies and interventions that directly address health disparities.

Abstract TP121: Using Visual Cues to Improve Dysphagia Screening Compliance in Acute Stroke Patients

Introduction: Dysphagia or difficulty swallowing after a stroke is a common neurological symptom which occurs in 35-67% of all acute stroke patients. Dysphagia can lead to complications such as aspiration, pneumonia, dehydration, weight loss or death. National guidelines recommend dysphagia screening before oral intake in stroke patients to reduce hospital acquired pneumonia. A dysphagia screening tool used by nurses at the bedside that allows for the direct observation of the patient’s ability to swallow is the Water Swallow Test. Upon analysis of patient data, a practice gap was identified in which the dysphagia screening was not performed prior to first oral intake of medication. With collaboration of our multi-disciplinary stroke team to identify opportunities for improvements in the dysphagia performance measure, we hypothesized that if a visual cue was in place prior to first oral administration of medication, we can improve our compliance in the dysphagia performance measure. Method: When a patient presents with stroke symptoms, a purple dot sticker will be placed on the patient’s identification band. This purple dot sticker will serve as a visual cue that will trigger a reminder to the nurse when scanning the patient’s identification band prior to administration of the first oral medication to perform the dysphagia screening. If screening has been performed and the patient passed, the purple sticker will be removed. If the patient fails the screening, the nurse will notify the provider and the patient will be kept NPO (no meds) pending a speech/swallow consult. Upon admission, SBAR handoff to the floor will include failure of dysphagia screening / NPO status and an order for a speech/swallow consult. Result: In 2022, the dysphagia screening compliance was 67%. Following the visual cue implementation, our compliance improved to 100% in June 2023 and 92% in July 2023. Conclusion: Preliminary metrics indicate that this tool has positively impacted our compliance rate. Education to the staff is ongoing. Integration of the visual tool into our hospital guidelines for care of the acute stroke patient is under consideration pending additional analysis of compliance rates.

Abstract TP113: Racial Disparities in Dysphagia Screening Outcomes Among Acute Stroke Patients at a United States Comprehensive Stroke Center

Introduction: Screening for dysphagia is vital in post-stroke care, with the Yale Swallow Protocol being a widely recognized tool. While passing the screening indicates a lower risk of dysphagia, racial disparities in screening results may also preclude patients from receiving a more comprehensive evaluation. Objective: This study aimed to investigate racial disparities in dysphagia screening outcomes in acute stroke patients at high risk for dysphagia based on initial NIHSS, explicitly focusing on the likelihood of black patients compared to non-black patients passing the Yale Swallow Protocol screening. Methods: Using data from a single US comprehensive stroke center, we examined the Yale Swallow Protocol dysphagia screening results amongst patients admitted for acute ischemic and hemorrhagic stroke with an initial NIHSS of 12 or greater between January 1 and December 31, 2022. Our NIHSS inclusion criteria was based on prior literature proposing an NIHSS score of 12 as a cutoff for a formal swallow evaluation. The primary outcome was the rate of passing the Yale Swallow Protocol screening, with data stratified by race. The association between race and swallow screening results was assessed using the chi-square test. A p-value of &lt;0.05 was considered statistically significant. Results: This study included 243 acute ischemic/hemorrhagic stroke patients, of which 99 were black. The chi-square test revealed a significant association between race and passing the dysphagia screen (p &lt;0.05). The odds of passing dysphagia screening were 2.13 times higher in black vs. non-black patients (OR 2.13, 95% CI 1.67-2.73). No statistically significant associations were found between passing the dysphagia screen and other factors such as age, gender, or NIHSS (p &gt;0.05 for all). Conclusion: These results underscore significant racial disparity in dysphagia screening outcomes, with black patients more likely to pass the initial screening. These findings raise concerns about potential missed opportunities for comprehensive speech and language pathology assessments in black patients. Further research to understand the underlying reasons for these disparities is needed to ensure comprehensive and equitable care for all patients.

Protocol for conducting a systematic review on diagnostic accuracy in clinical research

In the landscape of modern medicine, the ability to accurately diagnose various clinical conditions is paramount. As new diagnostic tools continue to emerge, their accuracy must be rigorously assessed before clinical implementation. This paper introduces a systematic review protocol tailored for diagnostic accuracy studies, drawing inspiration from a review on dysphagia screening in post-stroke patients. The protocol, designed with precision and transparency at its core, facilitates a thorough synthesis of evidence, employing tools such as the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) and the Standards for Reporting of Diagnostic Accuracy Studies (STARD) checklist for robust evaluation. The protocol emphasizes registration with the PROSPERO database and adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic search approach encompasses a comprehensive exploration of databases and precise keyword combinations. Distinctive inclusion and exclusion criteria, coupled with a dual-reviewer methodology, ensure the selection of high-quality studies. This framework has the potential to serve as a benchmark for systematic reviews in diagnostic accuracy, highlighting the importance of standardization, transparency, and adaptability in clinical research. This approach paves the way for a research methodology that delves deeper into diagnostic tools across various clinical scenarios, promoting evidence-based advancements in patient care.

INTERVENSI KEPERAWATAN UNTUK PENCEGAHAN KEJADIAN PNEUMONIA PADA PASIEN STROKE

Stroke patients are susceptible to respiratory problems and complications in the lungs, namely pneumonia, which most often occurs during stroke treatment. The aims of this study is to review the various literature on interventions that nurses can do to prevent and treat pneumonia in stroke patients. Search methods using electronic databases Science Direct, Scopus, Pubmed, and Google Scholar with a search range of 2017-2022. The inclusion criteria were research conducted on all stroke patients, both ischemic and hemorrhagic, the intervention given was a nursing action, and the outcome assessed was pneumonia. Five articles were reviewed and found several interventions used to prevent and reduce the incidence of pneumonia in stroke patients. Nursing actions that can be done are dysphagia screening and oral care. Conclusion: Dysphagia screening and and oral care can used to prevent and reduce the incidence of pneumonia in stroke patients.