Oropharyngeal Dysphagia after Stroke: Incidence, Diagnosis, and Clinical Predictors in Patients Admitted to a Neurorehabilitation Unit

Falsetti, Paolo; Acciai, Caterina; Palilla, Rosanna; Bosi, Marco; Carpinteri, Francesco; Zingarelli, A; Pedace, Claudio; Lenzi, Lucia

doi:10.1016/j.jstrokecerebrovasdis.2009.01.009

Cited by 213 publications

(183 citation statements)

References 37 publications

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“…The incidence of the nursing diagnosis Risk for Aspiration was similar to the one found in another study (15) . In regard to respiratory aspiration, its incidence in patients who experienced a CVA is around 50% and approximately half of these patients experience silent aspiration (5) .…”

Section: Resultsmentioning

confidence: 99%

“…The patients were allocated in the study at the time they were admitted in the cerebrovascular accident unit (initial assessment) and reassessed 48 hours after the first assessment. This period between the two assessments was established in accordance with the recommendations of researchers (2,(5)(6) , who stated that respiratory aspiration is a clinical condition that occurs to a lack of specialized personnel and the equipment required to perform videofluoroscopy, we checked the clinical signs proposed in two studies (7)(8) : dysphonia, dysarthria, abnormal gag reflex, abnormal voluntary cough, cough after swallowing, and voice change after swallowing. Two or more of six of these signs indicate respiratory aspiration.…”

Section: Methodsmentioning

confidence: 99%

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Clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced a cerebrovascular accident

Cavalcante

Araújo

Moreira

et al. 2013

Rev. Latino-Am. Enfermagem

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Objective: the study's objective was the clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced cerebrovascular accidents (CVA). Method: a prospective cohort study was conducted with 24 patients hospitalized due to a CVA. The instrument used to collect the data addressed the risk factors for respiratory aspiration, validated by concept analysis and by experts. Results: the most frequent risk factors for respiratory aspiration were: dysphagia (54.2%) and impaired physical mobility (41.7%). The prevalence of the nursing diagnosis Risk for Aspiration was 58.3% and the prevalence of respiratory aspiration over the span of 48 hours (monitoring period) was 37.5%. Risk factors for dysphagia and impaired physical mobility were significantly associated with respiratory aspiration. Conclusion: the risk factors dysphagia and impaired physical mobility are good predictors of the nursing diagnosis Risk for Aspiration. This study contributed to improving the NANDA-I Taxonomy and the systematization of the nursing process.Descriptors: Nursing; Nursing Diagnosis; Respiratory Aspiration; Stroke. Validación clínica del diagnóstico de enfermería riesgo de aspiración en pacientes con accidente cerebrovascularObjetivo: el estudio tiene como objetivo la validación clínica del diagnóstico de enfermería riesgo de aspiración en pacientes con accidente cerebrovascular. Método: un estudio de cohorte prospectivo desarrollado con 24 pacientes hospitalizados para el tratamiento del ictus agudo. El instrumento utilizado para la recolección de datos contiene los factores de riesgo de aspiración respiratoria, validado en el análisis conceptual y por expertos. Resultados: los factores de riesgo para aspiración respiratoria más presentes en los pacientes fueron: disfagia (54,2%) y disminución de la movilidad física (41,7%). La prevalencia del diagnóstico de enfermería riesgo de aspiración fue del 58,3% y la prevalencia en 48 horas (el tiempo del seguimiento) de la aspiración respiratoria fue de 37,5%. Los factores de riesgo disfagia y la disminución de la movilidad física se asociaron significativamente con la aspiración respiratoria. Conclusión: los factores de riesgo disminución de la movilidad física y disfagia son buenos predictores para el diagnóstico de enfermería riesgo de aspiración. Este trabajo permitió contribuir a la mejora de la taxonomía NANDA-I y, por lo tanto, el lenguaje de la sistematización de la atención de enfermería. MethodsThis observational study was conducted in the CVA unit of a public general tertiary hospital, a referral center Cavalcante TF, Araujo TL, Moreira RP, Guedes NG, Lopes MVO, Silva VM.medical diagnoses (aspiration pneumonia, pneumonitis and pulmonary embolism), as well as readings of X-rays.After this preliminary assessment, those who met all the inclusion criteria were assessed in terms of socio-demographic, clinical and predictor variables (risk factors) by means of interviews, physical assessments, and consultation of their medical charts. After 48 hours from the...

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced a cerebrovascular accident

Cavalcante

Araújo

Moreira

et al. 2013

Rev. Latino-Am. Enfermagem

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“…The coordination between the upper digestive and respiratory systems during swallowing is also essential for a safe and efficient feeding process (3) . A lack of coordination of the feeding and breathing processes can result in dysphagia, which includes changes in the swallowing process (4,5) . Swallowing disorders, also called dysphagia, are not considered a disease, but a symptom of some underlying disease.…”

Section: Introductionmentioning

confidence: 99%

Screening tools for dysphagia: a systematic review

Etges

Scheeren

Gomes

et al. 2014

CoDAS

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Purpose: To perform a systematic review of screening instruments for dysphagia available in the literature. Methods:For the selection of studies, the following descriptors were used: "questionários", "questionnaires", "transtornos de deglutição", "deglutition disorders", "programas de rastreamento", and "mass screening".The online databases used for the research were Virtual Health Library (LILACS, IBECS, MEDLINE, Cochrane Library, SciELO) and PubMed. The research was performed from April to June 2013. Selection criteria articles in English, Portuguese, and Spanish, regardless of the year of publication, whose title, abstract, or text had any relation to the purpose of the research. After reading the articles in their entirety, identification data and method of the articles were extracted for later analysis. Results: The research carried out from the proposed descriptors produced 1,012 articles. After reviewing the titles, summaries, and fully reading the articles, 20 studies were chosen. The publications on instruments for the identification of dysphagic patients started in 1999, and 50% of the analyzed studies were carried out in the USA. The methods used on the instruments were questionnaires, observation of patient's clinical signals and symptoms, the request for execution of some orofacial movements, and swallowing test with water or food. Conclusion: Screening instruments in dysphagia are fairly heterogeneous and have been developed for different audiences with the main objective of identifying patients with swallowing disorders. RESUMOObjetivo: Realizar a revisão sistemática dos instrumentos de rastreio em disfagia disponíveis na literatura. Estratégia de pesquisa:Para a seleção dos estudos, foram utilizados os seguintes descritores: "questionários", "questionnaires", "transtornos de deglutição", "deglutition disorders", "programas de rastreamento" e "mass screening" e foram utilizadas as bases de dados: Biblioteca Virtual em Saúde (LILACS, IBECS, MEDLINE, Biblioteca Cochrane, SciELO) e PubMed. A busca foi realizada no período entre abril e junho de 2013. Critérios de seleção:Foram selecionados artigos em Inglês, Português e Espanhol, independentemente do ano de publicação, que possuíam no título, resumo ou corpo do artigo relação com o objetivo da pesquisa. Análise dos dados: Após a leitura dos artigos na íntegra, foram extraídos dados de identificação e métodos dos artigos para posterior análise. Resultados: A pesquisa realizada a partir dos descritores propostos, nas bases de dados utilizadas, gerou o total de 1.012 artigos. Após a análise dos títulos, resumos e leitura dos artigos na íntegra, foram selecionados 20 estudos. As publicações sobre instrumentos para identificação de pacientes disfágicos iniciaram em 1999 e 50% dos artigos analisados foram desenvolvidos nos Estados Unidos. Os métodos empregados nos instrumentos foram: questionários, a observação de sinais e sintomas clínicos do paciente, a solicitação da execução de alguns movimentos orofaciais, teste de deglutição com água ou alime...

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“…does not classify dysphagia as a change in oral and/ or pharyngeal phase, unlike other tools concerned with data on the speech organs and swallowing biomechanics 9,[11][12][13][14][15][16] . This is because the dysphagia study in post-stroke patients in the acute phase should mainly focus the evaluation of the risk of bronchial aspiration and subsequent definition of a safer and more effective oral feeding 1,[3][4][5]9,27 . In this study, the GUSS scale allowed not only the identification of dysphagia, but also the classification of its severity and clinical changes of the acute phase of stroke.…”

Section: Discussionmentioning

confidence: 99%

“…The initial speech evaluation and prophylactic and therapeutic interventions in acute stroke patients are able to reduce the rates of dysphagia-related complications 1,[7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Evolução da deglutição no pós-AVC agudo: estudo descritivo

et al. 2016

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Purpose: to analyze the evolution of post-stroke swallowing impairment. Methods: this is a descriptive exploratory study involving a non-probabilistic sample that evaluated 100 stroke patients admitted at the Hospital Público Regional de Betim. Patients were subjected to a speech pathologist structured evaluation two times: in the first 48 hours after stroke and at hospital discharge. The Gugging Swallowing Screen, a standardized and validated bed-side tool for evaluating swallowing in stroke patients, was used. Results: in the initial evaluation, the frequency of dysphagia was 52%, and 28% of patients were classified as severe dysphagia with a high risk of aspiration. The mean time between the initial evaluation and hospital discharge was 22.1 days. At the hospital discharge, only 2.1% of patients still had severe dysphagia. It was observed change in the patient swallowing profile according to the severity of dysphagia. Conclusion: the frequency of post-stroke dysphagia is high, but there are progressive changes in the swallowing profile of stroke patients during their hospital stay. Keywords: Stroke; Deglutition Disorders; Clinical Evolution RESUMO Objetivo: analisar a evolução da deglutição de pacientes após acidente vascular cerebral. Métodos: trata-se de estudo exploratório descritivo com amostra não probabilística em que foram acompanhados 100 pacientes admitidos com o diagnóstico de acidente vascular cerebral no Hospital Público Regional de Betim. Os pacientes foram submetidos à avaliação fonoaudiológica estruturada em dois momentos: nas primeiras 48 horas após acidente vascular cerebral e no momento da alta hospitalar. Utilizou-se a escala Gugging Swallowing Screen que é um instrumento padronizado e validado para ser utilizado na beira do leito. Resultados: na avaliação fonoaudiológica inicial, a frequência da disfagia foi de 52%, sendo que 28% dos pacientes foram classificados como disfagia grave com alto risco de aspiração. A média de tempo entre a avaliação inicial da deglutição e a do momento da alta hospitalar foi de 22,1 dias. Na alta, apenas 2,1% dos pacientes ainda apresentavam disfagia grave. Observou-se mudança do perfil de deglutição do paciente de acordo com a gravidade da disfagia e da consistência da dieta oral. Conclusão: a frequência de disfagia após acidente vascular cerebral é alta, mas há progressiva mudança no perfil de deglutição do paciente durante o período de internação.

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Oropharyngeal Dysphagia after Stroke: Incidence, Diagnosis, and Clinical Predictors in Patients Admitted to a Neurorehabilitation Unit

Cited by 213 publications

References 37 publications

Clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced a cerebrovascular accident

Clinical validation of the nursing diagnosis Risk for Aspiration among patients who experienced a cerebrovascular accident

Screening tools for dysphagia: a systematic review

Evolução da deglutição no pós-AVC agudo: estudo descritivo

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