Background: At present, the flexible endoscopic evaluation of swallowing (FEES) is one of the most commonly used methods for the objective assessment of swallowing. This multicenter trial prospectively collected data on the safety of FEES and also assessed the impact of this procedure on clinical dysphagia management. Methods: Patients were recruited in 23 hospitals in Germany and Switzerland from September 2014 to May 2017. Patient characteristics, professional affiliation of the FEES examiners (physicians or speech and language therapists), side-effects and cardiorespiratory parameters, severity of dysphagia and clinical consequences of FEES were documented. Results: 2401 patients, mean age 69.8 (14.6) years, 42.3% women, were included in the FEES-registry. The most common main diagnosis was stroke (61%), followed by Parkinson's disease (6.5%). FEES was well tolerated by patients. Complications were reported in 2% of examinations, were all self-limited and resolved without sequelae and showed no correlation to the endoscopist's previous experience. In more than 50% of investigations FEES led to changes of feeding strategies, in the majority of cases an upgrade of oral diet was possible. Discussion: This study confirmed that FEES, even when performed by less experienced clinicians is a safe and well tolerated procedure and significantly impacts on the patients' clinical course. Implementation of a FEES-service in different clinical settings may improve dysphagia care. Trial registration: ClinicalTrials.gov NCT03037762, registered January 31st 2017.

In spite of the severity of neurological deficits, significant functional progress has been made. These results could be interpret as positive proof of the efficacy of neurological/neurosurgical early rehabilitation programs.

BackgroundColonization or infection with multi-drug resistant (MDR) bacteria is considered detrimental to the outcome of neurological and neurosurgical early rehabilitation patients.MethodsIn a German multi-center study, 754 neurological early rehabilitation patients were enrolled and and reviewed in respect to MDR status, length of stay (LOS) and the following outcome variables: Barthel Index (BI), Early Rehabilitation Index (ERI), Glasgow Outcome Score Extended (GOSE), Coma Remission Scale (CRS), Functional Ambulation Categories (FAC).ResultsThe mean age of the study population was 68.0 ± 14.8 years. Upon admission, the following prevalence for MDRs was observed: MRSA (methicillin resistant staphylococcus aureus) 7.0% (53/754), ESBL- (extended spectrum beta-lactamase) producing bacteria strains 12.6% (95/754), VRE (vancomycin resistant enterococci) 2.8% (21/754). Patients colonized or infected with MDR bacteria (MDR+) were significantly more frequently diagnosed with a critical illness polyneuropathy – CIP – than non-colonized (MDR-) patients: 29.0% vs. 14.8%. In addition, they were more frequently mechanically ventilated (MDR+: 55/138, 39.9%; MDR- 137/616, 22.2%). MDR+ patients were referred to rehabilitation earlier, had a longer LOS in early rehabilitation, lower BI on admission and at discharge, lower ERI on admission and lower CRS at discharge than MDR- patients. There was a highly significant correlation of the BI upon admission with the BI at discharge (rs = 0.492, p < 0.001). GOSE at discharge differed significantly between both groups (χ 2-test, p < 0.01). Perhaps of greatest importance, mortality among MDR+ was higher in comparison to MDR- (18.1% vs. 7.6%).ConclusionsThe outcome of neurological early rehabilitation patients colonized or infected with MDR bacteria including MRSA or ESBL producing strains is significantly poorer than by non-colonized patients. There is some evidence that the poor outcome could be related to the higher morbidity and lower functional status upon admission.

BackgroundEvaluation of functional status is difficult in neurological and neurosurgical early rehabilitation patients. The Early Rehabilitation Index (ERI) was introduced in Germany over 20 years ago, but since then validation studies are lacking. The ERI (range −325 to 0 points) includes highly relevant items including the necessity of intermittent mechanical ventilation or tracheostomy.MethodsThe present paper analyzed data from a German multi-center study, enrolling 754 neurological early rehabilitation patients. Together with ERI, Barthel Index (BI), Glasgow Coma Scale (GCS), Glasgow Outcome Score Extended, Coma Remission Scale (CRS), Functional Ambulation Categories and length of stay were obtained.ResultsERI showed significant improvements from admission to discharge (p < 0.001). In addition, there were significant correlations of the ERI upon admission and at discharge with BI, CRS and GCS.ConclusionsEvaluation of our study data suggest that the ERI may be used as a valid assessment instrument for neurological and neurosurgical early rehabilitation patients.

Zusammenfassung Hintergrund: Die Arbeitsgruppe neurologisch-neurochirurgische Fr?hrehabilitation (NNFR) hat im Jahr 2002 und im Jahr 2014 Verlaufsuntersuchungen von Patienten der NNFR durchgef?hrt. Die Studie stellt die Ergebnisse des Vergleiches aus den beiden Studien vor. Patienten und Methoden: Die Rehabilitationsverl?ufe in der NNFR wurden im Jahr 2002 von 9 Zentren und im Jahr 2014 von 16 Zentren erfasst und die Ergebnisse der Studien miteinander verglichen. Ergebnisse: Im Jahr 2002 wurden 1?280 Patienten und im Jahr 2014 754 Patienten in die Studien eingeschlossen. Im Vergleich der Studien wurden die Patienten vor Verlegung in die NNFR k?rzer im prim?r versorgenden Krankenhaus behandelt (2014 Median 23, 2002 Median 27; p<0,001) und es fanden sich ein h?heres Alter der Patienten (2014: 68,0?14,8 Jahre, 2002: 60,9?16,9 Jahre; p<0,001), ein h?herer Anteil an Patienten mit der Diagnose Critical-Illness-Polyneuropathie (CIP) (2014: 17,6%, 2002: 0%; p<0,001), ein h?herer Anteil an beatmeten Patienten (2014: 25,5%, 2002: 15,2%; p=0,007), eine h?here Mortalit?t (2014: 9,6%, 2002: 6,4%; p=0,031) und ein h?herer Anteil an Patienten, die in die weiterf?hrende Rehabilitation (Phase C) entlassen wurden (2014: 38%, 2002: 33%; p=0,024). In den Assessments Glasgow-Coma-Scala, Koma-Remissions-Skala, Barthel-Index und Fr?hreha-Index verbesserten sich die Patienten ?ber den Behandlungszeitraum und pro Woche in der Studie 2014 signifikant weniger ausgepr?gt als in der Studie 2002. Dagegen wurde 2014 ein signifikant h?herer Anteil von Patienten gehf?hig entlassen (2014: 53/702, 2002: 39/1?241; p<0,001). Die Verweildauern in der NNFR der bei Aufnahme nicht-beatmeten Patienten (2014: 49,0?42,2 Tage, 2002: 48,6?43,9) waren in beiden Studien vergleichbar. Diskussion: Der Vergleich beider Studien zeigt, dass sich die NNFR deutlich ver?ndert hat. Die Patienten sind in 2014 ?lter, h?ufiger beatmet und der Anteil an Patienten, die im Rahmen der prim?ren Krankenhausbehandlung sekund?r schwer neurologisch erkrankt sind (CIP), ist deutlich gestiegen. Zudem werden die Patienten fr?her in die NNFR verlegt. Nach Einsch?tzung der Autoren sind dies die wesentlichen Gr?nde, warum sich der klinische Zustand weniger verbesserte. Die Ergebnisse dieses Vergleiches best?tigen die Notwendigkeit, dass sich die Einrichtungen der NNFR auf immer schwerer betroffene, intensivpflichtige und beatmete Patienten einstellen m?ssen.