Clinical swallowing prognostic indicators in patients with acute ischemic stroke

Abstract

A swallowing disorder is present in more than 50% of patients with acute stroke. Objective To identify clinical prognostic indicators of the swallowing function in a population with acute ischemic stroke and to determine prioritization indicators for swallowing rehabilitation. Methods Participants were adults admitted to the emergency room who were diagnosed with acute ischemic stroke. Data gathering involved a swallowing assessment to determine the functional level of swallowing (American Speech-Language-Hearing Association National Outcome Measurement System – ASHA NOMS) and the verification of demographic and clinical variables. Results The study sample included 295 patients. For analysis purposes, patients were grouped as follows: ASHA NOMS levels 1 and 2 – ASHA1 (n = 51); levels 3, 4 and 5 – ASHA2 (n = 96); levels 6 and 7 – ASHA3 (n = 148). Statistical analyses indicated that patients who presented a poorer swallowing function (ASHA1) were older (age ≥ 70 years); had anterior circulation infarct; had lower scores on the Glasgow Coma Scale (GCS ≤ 14 points); took longer to initiate swallowing rehabilitation; had longer hospital stays; made more use of alternative feeding methods; needed more sessions of swallowing rehabilitation to remove alternate feeding methods; took longer to return to oral feeding and had poorer outcomes (fewer individuals discharged from swallowing rehabilitation sessions and increased mortality). Conclusion Patients with acute ischemic stroke, admitted to the emergency room, aged ≥ 70 years, score on the GCS ≤ 14, anterior circulation infarct and dementia should be prioritized for swallowing assessment and rehabilitation.

Characteristics of postintubation dysphagia in ICU patients in the context of the COVID-19 outbreak: A report of 920 cases from a Brazilian reference center

“…In the present study, the presence of Diabetes Mellitus, hypertension, acute myocardial infarction, heart disease, lung disease, kidney disease, stroke, other neurological diseases and higher death rates were associated with the group of non-resolved dysphagia. Our result corroborates those of other studies that indicated the prevalence of dysphagia in various pathologies such as heart disease, pulmonary disease, stroke and other neurologic diseases [ 41 , 42 ].…”

Fonoaudiología En Salas De Urgencias: Perspectiva Desde Una Revisión Documental

“…Se menciona la importancia de este tipo de acciones dentro de equipos interdisciplinares para la toma de decisiones clínicas de manera oportuna (Akhtar, y otros, 2016); (Reid, y otros, 2019); (Middleton, y otros, 2016); (Rodgers & Price, 2017); (Yong Kyun, Kyun Yeon, & Sang-Heon, 2018). Destaca el ejercicio profesional de fonoaudiólogo en la rehabilitación e intervención de la disfagia en pacientes con diversas condiciones, principalmente neurológicas, que puede generar riesgo para la vida y la calidad de vida de los usuarios y sus familias (Andrade, y otros, 2017); (Leite, Sassi, Medeiros, Comerlatti, & Andrade, 2019); (Muzerengi, Herd, Rick, & Clarke, 2016); (Schrock, Lou, Ball, & Van Etten, 2018); (Wates, Higginson, Kichenaradjou, & McVeigh, 2018). Las alteraciones de la deglución suelen ser marcadores tempranos y de alto impacto, por lo que, en urgencias es fundamental la detección y manejo oportuna para disminuir riesgos y asegurar direccionamiento médico clínico adecuado (Markle-Reid, y otros, 2020).…”

Fonoaudiología En Salas De Urgencias: Perspectiva Desde Una Revisión Documental

“…Se menciona la importancia de este tipo de acciones dentro de equipos interdisciplinares para la toma de decisiones clínicas de manera oportuna (Akhtar, y otros, 2016); (Reid, y otros, 2019); (Middleton, y otros, 2016); (Rodgers & Price, 2017); (Yong Kyun, Kyun Yeon, & Sang-Heon, 2018). Destaca el ejercicio profesional de fonoaudiólogo en la rehabilitación e intervención de la disfagia en pacientes con diversas condiciones, principalmente neurológicas, que puede generar riesgo para la vida y la calidad de vida de los usuarios y sus familias (Andrade, y otros, 2017); (Leite, Sassi, Medeiros, Comerlatti, & Andrade, 2019); (Muzerengi, Herd, Rick, & Clarke, 2016); (Schrock, Lou, Ball, & Van Etten, 2018); (Wates, Higginson, Kichenaradjou, & McVeigh, 2018). Las alteraciones de la deglución suelen ser marcadores tempranos y de alto impacto, por lo que, en urgencias es fundamental la detección y manejo oportuna para disminuir riesgos y asegurar direccionamiento médico clínico adecuado (Markle-Reid, y otros, 2020).…”