Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

Abstract

Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery.Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified.Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively.Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.

Prediction Models for Dysphagia in Intensive Care Unit after Mechanical Ventilation: A Systematic Review and Meta‐analysis

“…Eight of the nine included models were developed by logistic regression, 1,[19][20][21][22][30][31][32] and one was developed using the generalized additive model. 29 Of the nine models that were included, only two underwent internal validation, 19,31 while two others were subjected to external validation. 22,30 The adequacy of the sample size was evaluated based on the number of outcomes/events relative to the number of candidate predictors.…”

“…As far as the training set was concerned, in studies that reported discrimination and calibration, model discrimination was moderate to good, with AUC ranging from 0.78 22 to 0.98. 19 Calibration was reported for three models 1,21,22 with the Hosmer-Lemeshow test, with P-values ranging from 0.099 21 to 0.932. 22 Classification measures were based on varying risk cutoff values; model sensitivity ranged from 70.3% 31 to 94.34%, 30 and specificity from 68.06% 22 to 81.87%.…”

“…In particular, all models reported a low EPV (<10), which led to an increased risk of overfitting. Seven models had high risk in the analysis domain because of the absence of external validation (7 of 9, 89%), 1,[19][20][21]29,31,32 univariate pre-screening of variables (5 of 9, 56%), 1,19,21,29,31 and inappropriate handling of continuous and categorical predictors (4 of 9, 44%). [20][21][22]31 Bias was introduced through various means as summarized in Appendix 3.…”

“…18 As a result, the availability of FEES may be primarily limited to tertiary care ICUs. In a recent study, Zeng et al 19 found that conducting a standardized swallowing assessment (SSA) at the bedside is more convenient and safer than using videofluoroscopy or fibreoptic endoscopy, or the Kubota Water Swallowing Test. However, it still requires a well-trained nurse and is time-intensive.…”

Nutritional Supplements and Neuroprotective Diets and Their Potential Clinical Significance in Post-Stroke Rehabilitation

“…Neurogenic dysphagia can be caused by disturbances in the coordination of individual swallowing phases, paresis of the muscles involved in the act of swallowing, abnormal muscle tone, disturbance in swallowing-breathing coordination, disturbance of sensation in the mouth or throat, involuntary movements, disturbances in the central control of swallowing or most commonly a combination of these symptoms [18][19][20]. Neurogenic dysphagia is most often associated with neurological deficits that make it difficult to adopt and maintain a proper position while eating and can significantly reduce the critical insight into the symptoms presented.…”