Dysphagia in Patients with Brainstem Stroke

Meng, Nai‐Hsin; Wang, Tyng-Guey; Lien, I-Nan

doi:10.1097/00002060-200003000-00010

Cited by 166 publications

(116 citation statements)

References 14 publications

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“…This prevalence rate falls within the range reported from previous studies: 17 to 81 percent depending on the timing, methods, and criteria of diagnosis [1][2][10][11][12][13][14][15][16]. We found that the nursing admission dysphagia screening tool had relatively poor performance in terms of positive and negative predictive value.…”

Section: Discussionsupporting

confidence: 69%

Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: Nursing admission screening tool versus National Institutes of Health Stroke Scale

Bravata¹,

Daggett²,

Woodward-Hagg³

et al. 2009

JRRD

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Abstract-This study assessed the positive and negative predictive values and the sensitivity and specificity of a nursing dysphagia screening tool and the National Institutes of Health Stroke Scale (NIHSS) for the identification of dysphagia for veterans hospitalized with ischemic stroke. A secondary objective of this study was to evaluate the speech-language pathology consult rate before and after the nursing admission dysphagia screening tool. This retrospective cohort study evaluated veterans admitted to one Department of Veterans Affairs medical center with ischemic stroke during the 6 months both before and after the implementation of a nursing dysphagia screening tool, which was part of the admission nursing template. Stroke severity was measured with the use of the retrospective NIHSS. Dysphagia diagnosis was based on speechlanguage pathology evaluations. Dysphagia was present in 38 of 101 patients (38%) with ischemic stroke. The nursing dysphagia screening tool had a positive predictive value of 50% and a negative predictive value of 68%, with a sensitivity of 29% and specificity of 84%. The use of the NIHSS to identify dysphagia risk had a positive predictive value of 60% and a negative predictive value of 84%. The NIHSS had better test characteristics in predicting dysphagia than the nursing dysphagia screening tool. Future research should evaluate the use of the NIHSS as a screening tool for dysphagia.

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Section: Discussionsupporting

confidence: 69%

Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: Nursing admission screening tool versus National Institutes of Health Stroke Scale

Bravata¹,

Daggett²,

Woodward-Hagg³

et al. 2009

JRRD

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“…Sixteen of the selected articles estimated dysphagia incidence using more in-depth assessment techniques, such as clinician testing alone, 4,36,39,48,50 videofluoroscopic testing alone, 31,35,38 clinical and videofluoroscopic testing, 2,34,37,40,46,47,49 or endoscopic testing alone 45 (Table 2). Of the 7 studies using clinician and videofluoroscopic assessment, 4 2,40,47,49 administered videofluoroscopic testing to only those patients suspected to have dysphagia from clinician testing.…”

Section: Studies Using Comprehensive Swallowing Testsmentioning

confidence: 99%

“…2 The presence of dysphagia has been associated with an increased risk for pulmonary complications 3 and even mortality. 4 There is emerging evidence that early detection of dysphagia in patients with acute stroke reduces not only these complications but also reduces length of hospital stay and overall healthcare expenditures.…”

mentioning

confidence: 99%

Dysphagia After Stroke

Martino

Foley²,

Bhogal³

et al. 2005

Stroke

1,574

592

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Objective-To determine the incidence of dysphagia and associated pulmonary compromise in stroke patients through a systematic review of the published literature. Methods-Databases were searched (1966 through May 2005) using terms "cerebrovascular disorders," "deglutition disorders," and limited to "humans" for original articles addressing the frequency of dysphagia or pneumonia. Data sources included Medline, Embase, Pascal, relevant Internet addresses, and extensive hand searching of bibliographies of identified articles. Selected articles were reviewed for quality, diagnostic methods, and patient characteristics.Comparisons were made of reported dysphagia and pneumonia frequencies. The relative risks (RRs) of developing pneumonia were calculated in patients with dysphagia and confirmed aspiration. Results-Of the 277 sources identified, 104 were original, peer-reviewed articles that focused on adult stroke patients with dysphagia. Of these, 24 articles met inclusion criteria and were evaluated. The reported incidence of dysphagia was lowest using cursory screening techniques (37% to 45%), higher using clinical testing (51% to 55%), and highest using instrumental testing (64% to 78%). Dysphagia tends to be lower after hemispheric stroke and remains prominent in the rehabilitation brain stem stroke. There is increased risk for pneumonia in patients with dysphagia (RR, 3.17; 95% CI, 2.07, 4.87) and an even greater risk in patients with aspiration (RR, 11.56; 95% CI, 3.36, 39.77). Conclusions-The high incidence for dysphagia and pneumonia is a consistent finding with stroke patients. The pneumonia risk is greatest in stroke patients with aspiration. These findings will be valuable in the design of future dysphagia research.

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“…Thus, dysphagia is recognised as an important cause of morbidity and mortality after stroke [46]. To prevent these complications, guidelines recommend: (i.)…”

Section: Dysphagiamentioning

confidence: 99%