Fiberoptic Endoscopic Dysphagia Severity Scale Predicts Outcome after Acute Stroke

Abstract

Background and Purpose: Fiberoptic endoscopic evaluation of swallowing (FEES) is a suitable method for dysphagia assessment after acute stroke. Recently, we developed the fiberoptic endoscopic dysphagia severity scale (FEDSS) for acute stroke patients, grading dysphagia into 6 severity codes (1 to 6; 1 being best). The purpose of this study was to investigate the impact of the FEDSS as a predictor of outcomes at 3 months and intermediate complications during acute treatment. Methods: A total of 153 consecutive first-ever acute stroke patients were enrolled. Dysphagia was classified according to the FEDSS, assessed within 24 h after admission. Intermediate outcomes were pneumonia and endotracheal intubation. Functional outcome was measured by the modified Rankin Scale (mRS) at 3 months. Multivariate regression analysis was used to identify whether the FEDSS was an independent predictor of outcome and intercurrent complications. Analyses were adjusted for sex, age and National Institutes of Health Stroke Scale (NIH-SS) on admission. Results: The FEDSS was found to predict the mRS at 3 months as well as but independent from the NIH-SS. For each additional point on the FEDSS, the likelihood of dependency at 3 months (mRS ≥ 3) raised by ∼50%. Each increase of 1 point on the FEDSS conferred a more than 2-fold increased chance of developing pneumonia. The odds for the necessity of endotracheal intubation raised by a factor of nearly 2.5 with each additional point on the FEDSS. Conclusions: The FEDSS strongly and independently predicts outcome and intercurrent complications after acute stroke. Thus, a baseline FEES examination provides valuable prognostic information for the treatment of acute stroke patients.

Increase of Substance P Concentration in Saliva after Pharyngeal Electrical Stimulation in Severely Dysphagic Stroke Patients – an Indicator of Decannulation Success?

“…The reason for this might be seen in differences of the two patient cohorts. Thus, keeping in mind that overall stroke severity is among the most important risk factors for post-stroke dysphagia and its complications [43-45], the present study featured again a severely handicapped patient cohort with a higher rate of intracerebral hemorrhage (30% vs. 10%). Most importantly, the present trial allowed for a nearly unrestricted inclusion of patients.…”

Using the National Institute of Health Stroke Scale to Predict Dysphagia in Acute Ischemic Stroke

“…Few patients had lesions in the internal carotid artery and/or posterior circulation, which precluded statistical analysis [32]. In a study proposing a severity scale of dysphagia based on fiberoptic endocopic evaluation, 86.3% of the 153 patients studied, had ischemic stroke and 17.6% of these had lesions in the vertebrobasilar territory, and5.2% had combined vertebrobasilar and hemispheric strokes [33]. Among 563 patients admitted to hospital, only 20 (3.6%) patients with predominantly bulbar stroke were identified [24].…”

Oral Intake 6 Months after Acute Ischemic Stroke

“…Many previous authors have suggested other predictors for prolonged dysphagia after stroke (8,10,(20)(21)(22)(23), such as higher age, aphasia, absent gag reflex, and location of lesions in the frontal lobe or insular cortex. In the present study, independence before admission was also related to oral intake 6 months after onset.…”