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

Abstract

Background and Purpose: Oropharyngeal dysphagia is a common manifestation in acute stroke. Aspiration resulting from difficulties in swallowing is a symptom that should be considered due to the frequent occurrence of aspiration pneumonia that could influence the patient’s recovery as it causes clinical complications and could even lead to the patient’s death. The early clinical evaluation of swallowing disorders can help define approaches and avoid oral feeding, which may be detrimental to the patient. This study aimed to create an algorithm to identify patients at risk of developing dysphagia following acute ischemic stroke in order to be able to decide on the safest way of feeding and minimize the complications of stroke using the National Institutes of Health Stroke Scale (NHISS). Methods: Clinical assessment of swallowing was performed in 50 patients admitted to the emergency unit of the University Hospital, Faculty of Medicine of Ribeirão Preto, São Paulo, Brazil, with a diagnosis of ischemic stroke, within 48 h after the beginning of symptoms. Patients, 25 females and 25 males with a mean age of 64.90 years (range 26–91 years), were evaluated consecutively. An anamnesis was taken before the patient’s participation in the study in order to exclude a prior history of deglutition difficulties. For the functional assessment of swallowing, three food consistencies were used, i.e. pasty, liquid and solid. After clinical evaluation, we concluded whether there was dysphagia. For statistical analysis we used the Fisher exact test, verifying the association between the variables. To assess whether the NIHSS score characterizes a risk factor for dysphagia, a receiver operational characteristics curve was constructed to obtain characteristics for sensitivity and specificity. Results: Dysphagia was present in 32% of the patients. The clinical evaluation is a reliable method of detection of swallowing difficulties. However, the predictors of risk for the swallowing function must be balanced, and the level of consciousness and the presence of preexisting comorbidities should be considered. Gender, age and cerebral hemisphere involved were not significantly associated with the presence of dysphagia. NIHSS, Glasgow Coma Scale, and speech and language changes had a statistically significant predictive value for the presence of dysphagia. Conclusions: The NIHSS is highly sensitive (88%) and specific (85%) in detecting dysphagia; a score of 12 may be considered as the cutoff value. The creation of an algorithm to detect dysphagia in acute ischemic stroke appears to be useful in selecting the optimal feeding route while awaiting a specialized evaluation.

Association between neurological injury and the severity of oropharyngeal dysphagia after stroke

“…In a previous work, the topography of the lesion was significantly correlated to the presence or absence of dysphagia. Deglutition disorder was present in all patients (100%) with lesions of the carotid artery (29) . The presence of dysphagia is strongly associated with this subtype of stroke.…”

“…Some studies have presented the NIHSS score between 11 and 12 as the cut-off point for risk of dysphagia (10) . The use of the NIHSS is also suggested as an ideal marker in several studies that addressed the consequences of stroke (5,9,10,17,24,29) . Another study assessed the NIHSS score as a predictor for the use of percutaneous endoscopic gastrostomy (PEG) in hospitalized patients with acute ischemic stroke.…”

“…Of the 16 patients with dysphagia, 14 (87.5%) presented NIHSS scores ≥12 and two patients (12.5%) had scores of 10 and 11, with significant correlation between the NIHSS scores and the presence of dysphagia. It was concluded that the NIHSS is highly sensitive (88%) and specific (85%) in relation to dysphagia detection; a score of 12 may be considered as the cut-off point (29) . Although there are studies that indicate a score of ≥12 on the NIHSS as a cut-off point for dysphagia, the present survey was based on a classification system routinely used by the Neurology department of the hospital.…”

Acessibilidade à atenção fonoaudiológica em serviço de média complexidade

“…Furthermore, the expansion of neonatal hearing screening and access to primary care through the Family Health Strategy (FHS) increases the probability of detecting problems and risks in speech therapy. To minimize the disabilities and to develop communicative skills, speech therapy assistance needs to be done early, regularly and continuous through the regional and integrated healthcare network organization 8,9 .…”

“…The non-use of the waiting list with an appointment at MFS began only when the service had vacancy available to be filled in a short time, darkening the magnitude of excess of demand. Also minimized the waiting time for the first consultation: 76.3% of the children waited for 15 days, a short interval of time, comparing to six to seven months in Brazilian studies 7,[18][19][20] and other countries 9,22 .…”