Barbara Schumacher Finnegan1, Melissa M Meighan2, Noelani C Warren3, Meghan K Hatfield4, Stacey Alexeeff4, Jorge Lipiz5, Mai Nguyen-Huynh4,6. 1. Kaiser Permanente Northern California, Redwood City Medical Center, Redwood City, CA. 2. Kaiser Permanente Northern California Regional Licensing, Quality and Accreditation, Oakland, CA. 3. Kaiser Permanente Southern California, Moreno Valley Medical Center, Moreno Valley, CA. 4. Kaiser Permanente Northern California Division of Research, Oakland, CA. 5. Kaiser Permanente Southern California, Riverside Medical Center, Riverside, CA. 6. Kaiser Permanente Northern California, Diablo Service Area, Walnut Creek, CA.
Abstract
INTRODUCTION: Dysphagia occurs in up to 50% of patients with acute stroke symptoms, resulting in increased aspiration pneumonia rates and mortality. The purpose of this study was to validate a health system's dysphagia (swallow) screening tool used since 2007 on all patients with suspected stroke symptoms. Annual rates of aspiration pneumonia for ischemic stroke patients have ranged from 2% to 3% since 2007. METHODS: From August 17, 2015 through September 30, 2015, a bedside dysphagia screening was prospectively performed by 2 nurses who were blinded to all patients age 18 years or older admitted through the emergency department with suspected stroke symptoms at 21 Joint Commission accredited primary stroke centers in an integrated health system. The tool consists of 3 parts: pertinent history, focused physical examination, and progressive testing from ice chips to 90 mL of water. A speech language pathologist blinded to the nurse's screening results performed a formal swallow evaluation on the same patient. RESULTS: The end study population was 379 patients. Interrater reliability between 2 nurses of the dysphagia screening was excellent at 93.7% agreement (Ƙ = 0.83). When the dysphagia screenings were compared with the gold standard speech language pathologist professional swallow evaluation, the tool demonstrated both high sensitivity (86.4%; 95% confidence interval = 73.3-93.6) and high negative predictive value (93.8%; 95% confidence interval = 87.2-97.1). CONCLUSION: This tool is highly reliable and valid. The dysphagia screening tool requires minimal training and is easily administered in a timely manner.
INTRODUCTION:Dysphagia occurs in up to 50% of patients with acute stroke symptoms, resulting in increased aspiration pneumonia rates and mortality. The purpose of this study was to validate a health system's dysphagia (swallow) screening tool used since 2007 on all patients with suspected stroke symptoms. Annual rates of aspiration pneumonia for ischemic strokepatients have ranged from 2% to 3% since 2007. METHODS: From August 17, 2015 through September 30, 2015, a bedside dysphagia screening was prospectively performed by 2 nurses who were blinded to all patients age 18 years or older admitted through the emergency department with suspected stroke symptoms at 21 Joint Commission accredited primary stroke centers in an integrated health system. The tool consists of 3 parts: pertinent history, focused physical examination, and progressive testing from ice chips to 90 mL of water. A speech language pathologist blinded to the nurse's screening results performed a formal swallow evaluation on the same patient. RESULTS: The end study population was 379 patients. Interrater reliability between 2 nurses of the dysphagia screening was excellent at 93.7% agreement (Ƙ = 0.83). When the dysphagia screenings were compared with the gold standard speech language pathologist professional swallow evaluation, the tool demonstrated both high sensitivity (86.4%; 95% confidence interval = 73.3-93.6) and high negative predictive value (93.8%; 95% confidence interval = 87.2-97.1). CONCLUSION: This tool is highly reliable and valid. The dysphagia screening tool requires minimal training and is easily administered in a timely manner.
Authors: Christoph Palli; Simon Fandler; Kathrin Doppelhofer; Kurt Niederkorn; Christian Enzinger; Christian Vetta; Esther Trampusch; Reinhold Schmidt; Franz Fazekas; Thomas Gattringer Journal: Stroke Date: 2017-07-17 Impact factor: 7.914
Authors: Eric E Smith; David M Kent; Ketan R Bulsara; Lester Y Leung; Judith H Lichtman; Mathew J Reeves; Amytis Towfighi; William N Whiteley; Darin B Zahuranec Journal: Stroke Date: 2018-01-24 Impact factor: 7.914
Authors: Benjamin D Bray; Craig J Smith; Geoffrey C Cloud; Pam Enderby; Martin James; Lizz Paley; Pippa J Tyrrell; Charles D A Wolfe; Anthony G Rudd Journal: J Neurol Neurosurg Psychiatry Date: 2016-06-13 Impact factor: 10.154