Towards a Basic Endoscopic Assessment of Swallowing in Acute Stroke – Development and Evaluation of a Simple Dysphagia Score

Abstract

Background and Purpose: Dysphagia is an important complication of acute stroke with a reported incidence of up to 76%. The purpose of this investigation was to develop and to evaluate an endoscopic scoring system which has the potential to guide dysphagia management in acute stroke patients. Methods: A fiberoptic endoscopic evaluation of swallowing (FEES) was carried out in 100 patients within 72 h of stroke onset. During endoscopic examination, the secretion status was evaluated, and the patient was successively given standard volumes of puree consistency, liquids and soft solid food. Penetration and aspiration was assessed using a 5-point scale. Results: Nearly 80% of patients showed penetration or aspiration during FEES. These events occurred more frequently with liquids and soft solid food than with puree. Penetration or aspiration at any stage of examination predicted failure at the subsequent food consistency. Furthermore, key findings of endoscopic evaluation were predictive of the need for later orotracheal intubation. Based on these observations a score was developed that grades stroke-related dysphagia according to the risk of penetration or aspiration of the different food consistencies tested. Assessment of interrater reliability by means of 25 additional endoscopic examinations resulted in excellent agreement between three investigators, reflected by a ĸ coefficient of 0.89. Conclusion: Stroke-related dysphagia may effectively be graded using a simple endoscopic scoring system. The usefulness of this screening protocol with respect to patient outcome and intercurrent complications has to be studied in prospective clinical trials.

Fiberoptic Endoscopic Dysphagia Severity Scale Predicts Outcome after Acute Stroke

“…All subjects were endoscopically assessed in accordance with our protocol for fiberoptic endoscopic assessment of dysphagia in acute stroke patients, which we had previously developed and evaluated [14]. Following this protocol each examined patient was classified according to a 6-point scoring system that grades dysphagia severity and allows a quick deduction of clinical consequences (FEDSS) (fig.…”

“…Fiberoptic endoscopic evaluation of swallowing (FEES) has been shown to be an excellent bedside method for a quick, safe and precise dysphagia assessment in the first days after stroke [13,14,15,16,17,18]. Recently, we developed and evaluated a FEES-based swallowing performance scale for acute stroke patients that allows for a differentiated and reliable classification of stroke-related dysphagia into 6 severity codes based on easy-to-identify endoscopic findings (see below) [14, 19]. …”

Predictive Factors for Percutaneous Endoscopic Gastrostomy in Patients with Spontaneous Intracranial Hemorrhage

“…If aspiration was assumed because of pathological water swallowing tests [42][43][44][45] , fiberoptic endoscopic evaluation of swallowing was performed [46][47][48][49][50][51] . Patients with aspiration were monitored for at least fourteen days.…”

The Safety of Fiberoptic Endoscopic Evaluation of Swallowing in Acute Stroke Patients

“…8,18 In brief, all patients were evaluated at bedside on the local stroke unit with the upper part of the body being elevated. The endoscope was passed through the most patent nostril without administration of a topical anesthetic or vasoconstrictor and was then moved forward along the floor of the nose through the velopharyngeal port.…”