Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke

Ribeiro, Paulo Domingos; Cola, Paula Cristina; Gatto, Ana Rita; Silva, Roberta Gonçalves da; Luvizutto, Gustavo José; Braga, Gabriel Pereira; Schelp, Arthur Oscar; Henry, Maria Aparecida Coelho de Arruda; Bazan, Rodrigo

doi:10.1016/j.jstrokecerebrovasdis.2015.05.009

Cited by 38 publications

(23 citation statements)

References 37 publications

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“…In line with this reasoning, lower NIH-SS cutoff values for infratentorial strokes triggering an instrumental swallowing assessment were found in our study. The fact that the NIH-SS shows less sensitivity for items involving the vertebral-basilar system may also explain why Ribeiro et al [19], unlike our results, found no significant relation between laryngeal penetration or aspiration and the NIH-SS in a mixed stroke population in an earlier study.…”

Section: Discussioncontrasting

confidence: 93%

“…Few studies have addressed the role of the NIH-SS as a predictor for PSD [14][15][16][17][18][19] with inconclusive results due to variability in study design and patient selection, for example, in 1 study dysphagia was only found in supratentorial stroke patients [16]. A further limitation has been that diagnostic criteria for dysphagia in these studies were substantially variable and only few used instrumental assessment, that is, VFS [14].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussioncontrasting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Age [1718], black race [18], initial GCS score [18], ICH volume [1819] and Functional Independence Measure (FIM) scores on admission [17] were known to be independent predictors for long-term dysphagia in patients with hemorrhagic stroke. In comparison, the NIHSS score [2021], age [202122], left-sided lesion [23], history of diabetes [22], and baseline functional independence [21] were risk factors for dysphagia in ischemic stroke. The GCS is the one of the important prognostic factors for functional recovery in aSAH [24]: the poor neurological status at the onset as captured by the GCS and NIHSS affected the prognosis of dysphagia in both ischemic and hemorrhagic strokes as a result.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Patients With Aneurysmal Subarachnoid Hemorrhage and Risk Factors Related to Dysphagia

et al. 2016

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ObjectiveTo investigate the characteristics and risk factors of dysphagia with the Videofluoroscopic Dysphagia Scale (VDS) using a videofluoroscopic swallowing study (VFSS) in patients with ruptured aneurysmal subarachnoid hemorrhage (aSAH).MethodsData of 64 patients presenting with first-ever ruptured aSAH were analyzed. Characteristics of dysphagia were evaluated using VFSS and all subjects were divided into a high (>47) and low risk group (≤47) by the VDS score. Clinical and functional parameters were assessed by medical records including demographics, hypertension and diabetes mellitus (DM), the Glasgow Coma Scale (GCS), the Hunt and Hess scale, endotracheal intubation, acute management modalities, as well as Korean version of the Mini-Mental Status Examination (K-MMSE) and Korean version of Modified Barthel Index (K-MBI). Radiologic factors identified the amount of hemorrhage, ventricular rupture, and aneurysmal location.ResultsAbout a half of the subjects showed oral phase abnormalities and the oral transit time was delayed in 46.8% of the patients. The pharyngeal transit time was also prolonged in 39.0% of the subjects and the proportion of penetration and aspiration observed was 46.8%. The parameters-GCS score (p=0.048), hemorrhagic volume (p=0.028), presence of intraventricular hemorrhage (p=0.038), and K-MMSE (p=0.007)-were predisposing factors for dysphagia in patients with aSAH.ConclusionAbnormalities in the oral phase were more prominent in patients with aSAH than in those with other types of stroke. The risk factors associated with dysphagia persisting over 6 months after stroke onset were the initial GCS, hemorrhage volume, presence of intraventricular hemorrhage, and cognitive status as measured by the K-MMSE.

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“…A retrospective case series reported by Pikus and colleagues lends credence to the idea that divisions of airway invasion by depth (i.e., PAS level 1 vs levels 2–5, levels 6–7 and level 8) are associated with relative risk for pneumonia [ 23 ]. However, other studies suggest that the relationship is not that straight forward [ 25 ]. It is well accepted in clinical circles that not every patient with tracheobronchial aspiration (whether sensate or silent) will progress to developing pneumonia [ 24 , 26 ].…”

Section: Construct Validitymentioning

confidence: 99%

Reflections on Clinical and Statistical Use of the Penetration-Aspiration Scale

2017

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The 8-point Penetration-Aspiration Scale (PAS) was introduced to the field of dysphagia in 1996 and has become the standard method used by both clinicians and researchers to describe and measure the severity of airway invasion during swallowing. In this article, we review the properties of the scale and explore what has been learned over 20 years of use regarding the construct validity, ordinality, intervality, score distribution, and sensitivity of the PAS to change. We propose that a categorical revision of the PAS into four levels of increasing physiological severity would be appropriate. The article concludes with a discussion of common errors made in the statistical analysis of the PAS, proposing that frequency distributions and ordinal logistic regression approaches are most appropriate given the properties of the scale. A hypothetical dataset is included to illustrate both the problems and strengths of different statistical approaches.

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Relationship between Dysphagia, National Institutes of Health Stroke Scale Score, and Predictors of Pneumonia after Ischemic Stroke

Abstract: There was no relation between the NIHSS score and laryngeal penetration or laryngotracheal aspiration, and the principal predictors of pneumonia in dysphagic patients after ischemic stroke were advanced age and neurologic severity.

Cited by 38 publications

References 37 publications

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

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

Characteristics of Patients With Aneurysmal Subarachnoid Hemorrhage and Risk Factors Related to Dysphagia

Reflections on Clinical and Statistical Use of the Penetration-Aspiration Scale

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