Prediction of Outcome in Neurogenic Oropharyngeal Dysphagia within 72 Hours of Acute Stroke

Ickenstein, Guntram W.; Höhlig, C; Prosiegel, Mario; Koch, Horst J.; Dziewas, Rainer; Bodechtel, Ulf; Müller, Rainer; Reichmann, Heinz; Riecker, Axel

doi:10.1016/j.jstrokecerebrovasdis.2011.01.004

Cited by 74 publications

(80 citation statements)

References 35 publications

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“…Our findings are in the lower range of previous reports indicating that dysphagia is present in one-third to onehalf of the patients with acute stroke. [2][3][4][5][6][7] Although swallowing function improves during the first days after the stroke in many patients, 38 appropriate management is essential not only to prevent aspiration pneumonia but also to ensure that nutritional needs are met early.…”

Section: Discussionmentioning

confidence: 99%

“…Studies in different patient populations indicate that up to half of the patients admitted to hospital with acute stroke may be undernourished and that probably as many initially present with dysphagia. [1][2][3][4][5][6][7] Undernutrition develops as a consequence of insufficient protein and energy intake over time, leading to altered body composition and impaired biological function. In patients with acute stroke, undernutrition is an independent risk factor for poorer functional outcomes that is potentially modifiable.…”

Section: Introductionmentioning

confidence: 99%

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Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit

Kampman

Eltoft

Karaliute

et al. 2015

The Neurohospitalist

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Background and Purpose: In patients with acute stroke, undernutrition and aspiration pneumonia are associated with increased mortality and length of hospital stay. Formal screening for nutritional risk and dysphagia helps to ensure optimal nutritional management in all patients with stroke and to reduce the risk of aspiration in patients with dysphagia. We developed a national guideline for nutritional and dysphagia screening in acute stroke, which was introduced in our stroke unit on June 1, 2012. The primary objective was to audit adherence to the guideline and to achieve full implementation. Second, we assessed the prevalence of nutritional risk and dysphagia. Methods: We performed a chart review to assess performance of screening for nutritional risk and dysphagia in all patients with stroke hospitalized for ≥ 48 hours between June 1, 2012, and May 31, 2013. Next we applied a ''clinical microsystems approach'' with rapid improvement cycles and audits over a 6-month period to achieve full implementation. Results: The chart review showed that nutritional risk screening was performed in 65% and swallow testing in 91% of eligible patients (n ¼ 185). Proactive implementation resulted in >95% patients screened (n ¼ 79). The overall prevalence of nutritional risk was 29%, and 23% of the patients failed the initial swallow test. Conclusions: Proactive implementation is required to obtain high screening rates for nutritional risk and swallowing difficulties using validated screening tools. The proportion of patients at nutritional risk and the prevalence of dysphagia at initial swallow test were in the lower range of previous reports.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit

Kampman

Eltoft

Karaliute

et al. 2015

The Neurohospitalist

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“…According to a systematic review of screening dysphagia risk in patients with stroke by Daniels et al [28], in studies with direct assessment of swallowing, the majority (10 of 11 studies) used WSTs. Many such screenings, including WST, are carried out within the first 24 h (within 72 h at the latest) after stroke to triage dysphagia [29,30,31,32,33]. The use of water may render the test feasible and easier to administer [28], especially in acute stroke care.…”

Section: Discussionmentioning

confidence: 99%

Water-Swallowing Test: Screening for Aspiration in Stroke Patients

2013

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Background and Purpose: The water-swallowing test (WST) is frequently used in clinical practice as a functional assessment to detect aspiration and prevent pneumonia. It is a standardized test used all over the world, but the amount of water given varies depending on the examiner. Furthermore, there are very few reports on the simultaneous performance of the WST and videofluorography (VF). This study compared the amount of swallowed water to investigate the reliability of WST to exclude aspiration following acute stroke. Methods: We assessed 111 stroke patients (65 men and 46 women) with suspected dysphagia/difficulty in swallowing and performed VF upon obtaining consent from the patients and their families. Patients were aged between 20 and 98 years (65.6 ± 13.4 years); 64 had cerebral infarction, 26 cerebral hemorrhage, 13 subarachnoid hemorrhage, and 8 had other cerebrovascular disease. The time from stroke onset to VF was 16.6 ± 10.3 days (range, 2-55). WSTs using 5, 10, 30, and 60 ml and the modified WST (MWST) were performed during VF. Results: We found that the number of instances of choking, cough, wet voice, and aspiration increased with higher amounts of water. The sensitivity and specificity of WST for aspiration ranged from 34.8 to 55.7% and from 78.9 to 93.2%, respectively. The MWST, which used only 3 ml of water, yielded a sensitivity of 55.3% and a specificity of 80.8% for aspiration. There was a positive correlation between the time for one swallow and age, but there was no difference between genders. There was also no connection between clinical findings during WST or the presence of aspiration with the number of swallows, swallowing speed, or time for one swallow. Conclusions: WSTs are not as powerful as VF as a screening instrument in acute stroke. WSTs with more water detected aspiration with greater sensitivity, but there is no justification for overconfidence when investigating aspiration. We recommend using WST as well as VF to investigate swallowing in stroke patients.

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“…It is known that from the post-CVA patients, 25-50% complained of dysphasia 18 , and some authors even suggest higher probabilities occurrence 8 . Specific studies about the epidemiology aspects and natural history of dysphasia associated with acute brain-vascular conditions suggest an incidence of around 50% for swallowing disorders 19,20 .…”

Section: Discussionmentioning

confidence: 99%

Investigação da queixa de disfagia em pacientes afásicos

Ortiz

Marinelli

2013

Rev. CEFAC

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OBJETIVOS: verificar a presença e evolução da queixa de deglutição em pacientes afásicos pós- AVE e, a partir do relato dos familiares em relação à melhora das manifestações, analisar se a ocorrência da afasia interferiu no prognóstico da disfagia. MÉTODO: 30 pacientes afásicos pós-AVE na fase crônica foram entrevistados e, juntamente com seus familiares, responderam a um questionário sobre a presença e a permanência de queixas de deglutição pós-AVE e aspectos relacionados, bem como melhoras ocorridas em relação aos quadros de disfagia e afasia. Para verificar se a disfagia parece ter interferido no prognóstico da afasia, comparou-se as curvas de Kaplan-Meier dos pacientes que referiram queixas de disfagia com os que não referiram. RESULTADOS: 48% dos pacientes tiveram queixas de dificuldades de deglutição pós-AVE. Destes, 93% apresentaram mudanças positivas (melhora parcial ou total do quadro). O tempo médio para que o paciente apresentasse qualquer tipo de mudança (espontânea ou não) foi de 76 dias. 60% referiu melhora total da disfagia, sendo que 47% foram submetidos à terapia fonoaudiológica. Em relação à afasia, 87% dos pacientes referiram melhora, apesar de nenhum paciente ter referido melhora total. 57% haviam sido expostos à terapia fonoaudiológica para a afasia. O tempo médio referido para que o paciente apresentasse qualquer tipo de mudança positiva nas manifestações foi de 183 dias. Não houve diferença significante na melhora da afasia entre o grupo com e sem queixa de deglutição. CONCLUSÕES: dos pacientes afásicos avaliados neste estudo, 48% apresentou queixa de disfagia. Verificou-se, a partir do relato dos familiares, que a ocorrência da afasia parece não ter interferido no prognóstico da disfagia.

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Prediction of Outcome in Neurogenic Oropharyngeal Dysphagia within 72 Hours of Acute Stroke

Cited by 74 publications

References 35 publications

Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit

Full Implementation of Screening for Nutritional Risk and Dysphagia in an Acute Stroke Unit

Water-Swallowing Test: Screening for Aspiration in Stroke Patients

Investigação da queixa de disfagia em pacientes afásicos

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