scholarly journals Measurement of Oxygen Desaturation Is Not Useful for the Detection of Aspiration in Dysphagic Stroke Patients

2017 ◽  
Vol 7 (1) ◽  
pp. 44-50 ◽  
Author(s):  
Thomas Marian ◽  
Jens Schröder ◽  
Paul Muhle ◽  
Inga Claus ◽  
Stephan Oelenberg ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Screening Tool ◽  
Oxygen Desaturation ◽  
Screening Tools ◽  
Endoscopic Evaluation ◽  
National Guidelines ◽  
Stroke Patients ◽  
Severe Dysphagia ◽  
A Minor ◽  
Swallowing Assessment

Background: Dysphagia is one of the most dangerous symptoms of acute stroke. Various screening tools have been suggested for the early detection of this condition. In spite of conflicting results, measurement of oxygen saturation (SpO2) during clinical swallowing assessment is still recommended by different national guidelines as a screening tool with a decline in SpO2 ≥2% usually being regarded as a marker of aspiration. This paper assesses the sensitivity of SpO2 measurements for the evaluation of aspiration risk in acute stroke patients. Methods: Fifty acute stroke patients with moderate to severe dysphagia were included in this study. In all patients, fiberoptic endoscopic evaluation of swallowing (FEES) was performed according to a standardised protocol. Blinded to the results of FEES, SpO2 was monitored simultaneously. The degree of desaturation during/after swallows with aspiration was compared to the degree of desaturation during/after swallows without aspiration in a swallow-to-swallow analysis of each patient. To minimise potential confounders, every patient served as their control. Results: In each subject, a swallow with and a swallow without aspiration were analysed. Overall, aspiration seen in FEES was related to a minor decline in SpO2 (mean SpO2 without aspiration 95.54 ± 2.7% vs. mean SpO2 with aspiration 95.28 ± 2.7%). However, a significant desaturation ≥2% occurred only in 5 patients during/after aspiration. There was no correlation between aspiration/dysphagia severity or the amount of aspirated material and SpO2 levels. Conclusions: According to this study, measurement of oxygen desaturation is not a suitable screening tool for the detection of aspiration in stroke patients.

scholarly journals Validation of a Dysphagia Screening Tool in Acute Stroke Patients

2010 ◽  
Vol 19 (4) ◽  
pp. 357-364 ◽  
Author(s):  
Jeff Edmiaston ◽  
Lisa Tabor Connor ◽  
Lynda Loehr ◽  
Abdullah Nassief
Keyword(s):  
Acute Stroke ◽  
Health Care Professionals ◽  
Screening Tool ◽  
Tertiary Care ◽  
Screening Tools ◽  
Care Hospital ◽  
Stroke Patients ◽  
Aspiration Risk ◽  
The Mean ◽  
Mean Time

Background Although many dysphagia screening tools exist, none has high sensitivity and reliability or can be administered quickly with minimal training. Objective To design and validate a swallowing screening tool to be used by health care professionals who are not speech language pathologists to identify dysphagia and aspiration risk in acute stroke patients. Methods In a prospective study of 300 patients admitted to the stroke service at an urban tertiary care hospital, interrater and test-retest reliabilities of a new tool (the Acute Stroke Dysphagia Screen) were established. The tool was administered by nursing staff when patients were admitted to the stroke unit. A speech language pathologist blinded to the results with the new tool administered the Mann Assessment of Swallowing Ability, a clinical bedside evaluation, with dysphagia operationally defined by a score less than 178. Results The mean time from admission to screening with the new tool was 8 hours. The mean time between administration of the new tool and the clinical bedside evaluation was 32 hours. For the new tool, interrater reliability was 93.6% and test-retest reliability was 92.5%. The new tool had a sensitivity of 91% and a specificity of 74% for detecting dysphagia and a sensitivity of 95% and a specificity of 68% for detecting aspiration risk. Conclusions The Acute Stroke Dysphagia Screen is an easily administered and reliable tool that has sufficient sensitivity to detect both dysphagia and aspiration risk in acute stroke patients.

scholarly journals The South African dysphagia screening tool (SADS): A screening tool for a developing context

2016 ◽  
Vol 63 (1) ◽  
Author(s):  
Calli Ostrofsky ◽  
Jaishika Seedat
Keyword(s):  
At Risk ◽  
Acute Stroke ◽  
South African ◽  
Screening Tool ◽  
Diagnostic Assessment ◽  
The South ◽  
Stroke Patients ◽  
Cohen’S Kappa ◽  
Cohen's Kappa ◽  
Government Hospitals

Background: Notwithstanding its value, there are challenges and limitations to implementing a dysphagia screening tool from a developed contexts in a developing context. The need for a reliable and valid screening tool for dysphagia that considers context, systemic rules and resources was identified to prevent further medical compromise, optimise dysphagia prognosis and ultimately hasten patients’ return to home or work.Methodology: To establish the validity and reliability of the South African dysphagia screening tool (SADS) for acute stroke patients accessing government hospital services. The study was a quantitative, non-experimental, correlational cross-sectional design with a retrospective component. Convenient sampling was used to recruit 18 speech-language therapists and 63 acute stroke patients from three South African government hospitals. The SADS consists of 20 test items and was administered by speech-language therapists. Screening was followed by a diagnostic dysphagia assessment. The administrator of the tool was not involved in completing the diagnostic assessment, to eliminate bias and prevent contamination of results from screener to diagnostic assessment. Sensitivity, validity and efficacy of the screening tool were evaluated against the results of the diagnostic dysphagia assessment. Cohen’s kappa measures determined inter-rater agreement between the results of the SADS and the diagnostic assessment.Results and conclusion: The SADS was proven to be valid and reliable. Cohen’s kappa indicated a high inter-rater reliability and showed high sensitivity and adequate specificity in detecting dysphagia amongst acute stroke patients who were at risk for dysphagia. The SADS was characterised by concurrent, content and face validity. As a first step in establishing contextual appropriateness, the SADS is a valid and reliable screening tool that is sensitive in identifying stroke patients at risk for dysphagia within government hospitals in South Africa.

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

Stroke ◽  
2009 ◽  
Vol 40 (2) ◽  
pp. 482-486 ◽  
Author(s):  
Tobias Warnecke ◽  
Inga Teismann ◽  
Stefan Oelenberg ◽  
Christina Hamacher ◽  
E. Bernd Ringelstein ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Endoscopic Evaluation ◽  
Stroke Patients

scholarly journals Dysphagia screening tools for acute stroke patients available for nurses: A systematic review

2019 ◽  
Author(s):  
Isabel de Jesus Oliveira ◽  
Liliana Andreia Neves Da Mota ◽  
Susana Vaz Freitas ◽  
Pedro Lopes Ferreira
Keyword(s):  
Systematic Review ◽  
Acute Stroke ◽  
Methodological Quality ◽  
Selection Index ◽  
Significant Proportion ◽  
Screening Tools ◽  
Quality Analysis ◽  
Diagnostic Process ◽  
Index Test ◽  
Stroke Patients

Background & Aim: There is a high incidence of dysphagia after stroke that, depending on the assessment, methodology and time elapsed, can range from 8.1% to 80%. Early and systemic dysphagia screening is associated with a decreased risk of aspiration pneumonia and prevents inadequate hydration/nutrition. The purpose of this systematic review was to identify dysphagia screening tools for acute stroke patients available for nurses validated against reference test. The research question was: which dysphagia screening tools for acute stroke patients available for nurses? Methods & Materials: Three electronic databases were searched from January 2007 to November 2017: on PubMed, Scielo and CINAHL Plus. Two independent reviewers screened all titles and abstracts, assessed methodological quality and extracted data. The methodological quality analysis and evaluation was guided according to four domains: patient selection, index test, reference standard and flow and timing. Divergences between reviewers in data extraction were consensualized through discussion. Results: From the 377 articles retrieved, only three articles met criteria for review: Barnes-Jewish Hospital-Stroke Dysphagia Screen; the Gugging Swallowing Screen and, The Toronto Bedside Swallowing Screening Test. None of the screening tools complies with all psychometric properties, which means that a still significant proportion of patients will be kept nil by mouth without being necessary or that some patients will “fall through the cracks” interrupting the diagnostic process. The tools identified are different from each other, making their comparison impracticable. Conclusion: Due to psychometric proprieties and dietary recommendations adjusted to dysphagia severity, of all available tools, GUSS is a suitable screening tool for nurses in clinical practice.  

scholarly journals Delirium in Acute Stroke: A Survey of Screening and Diagnostic Practice in Scotland

ISRN Stroke ◽  
2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Gail Carin-Levy ◽  
Kath Nicol ◽  
Frederike van Wijck ◽  
Gillian E. Mead
Keyword(s):  
Acute Stroke ◽  
Clinical Judgment ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Screening Tools ◽  
Diagnostic Tools ◽  
Free Text ◽  
Stroke Patients ◽  
Nominal Data ◽  
Doctors And Nurses

Aims. To survey the use of delirium screening and diagnostic tools in patients with acute stroke across Scotland and to establish whether doctors and nurses felt the tools used were suitable for stroke patients. Methods. An invitation to participate in a web-based survey was e-mailed to 217 doctors and nurses working in acute stroke across Scotland. Descriptive statistics were used to report nominal data, and content analysis was used to interpret free text responses. Results. Sixty-five responses were logged (30% return rate). 48% of the respondents reported that they routinely screened newly admitted patients for delirium. Following initial screening, 38% reported that they screened for delirium as the need arises. 43% reported using clinical judgment to diagnose delirium, and 32% stated that they combined clinical judgment with a standardised tool. 28% of the clinicians reported that they used the Confusion Assessment Method; however, only 13.5% felt that it was suitable for stroke patients. Conclusions. Screening for delirium is inconsistent in Scottish stroke services, and there is uncertainty regarding the suitability of screening tools with stroke patients. As the importance of early identification of delirium on stroke outcomes is articulated in recent publications, validating a screening tool to detect delirium in acute stroke is recommended.

scholarly journals Evaluation of Swallowing Disorder in Ischemic Stroke Patients By Flexible Endoscopic

2019 ◽  
Vol 7 (01) ◽  
pp. 20
Author(s):  
Nur Indah Lestari Lestari ◽  
Widjajalaksmi Kusumaningsih ◽  
Salim Harris ◽  
Susyana Tamin ◽  
Retno Asti Werdhani
Keyword(s):  
Ischemic Stroke ◽  
Cross Sectional Study ◽  
Swallowing Disorder ◽  
Endoscopic Evaluation ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Cough Reflex ◽  
Swallowing Dysfunction ◽  
Complications Of Stroke ◽  
Swallowing Assessment

Introduction: Dysphagia is one of the complications of stroke and closely associated with increasing of aspiration pneumonia. Evaluation of dysphagia was necessary to prevent pneumonia due to aspiration has effectively done by fiberoptic endoscopic evaluation of swallowing (FEES).Methods: The study was a cross sectional study with convenience sampling. The subjects were stroke outpatients from July to December 2018. The FEES was conducted to assess the swallowing dysfunction and the data were collected.Results: There was six post ischemic stroke subjects, mean age (SD) was 55.17 (9.13) years and 4 subjects were male. All subjects had standing secretion in pre-swallowing assessment. 3 subjects used nasogastric tube (NGT) to fulfill the intake safely. In swallowing assessment, all subjects had residue at vallecula and/or pyriformis sinus. 2 subjects had penetration only and 4 subjects had penetration with aspiration. There was inadequate cough reflex in 2 subjects.Conclusion: Standing secretion and residue became the most dominant findings in post ischemic stroke patients, which a risk to have Aspiration.Keywords: Swallowing Disorder, Stroke, Flexible Endoscopic Evaluation of Swallowing (FEES)

Abstract W P224: SOS Score: an Optimized Score to Screen Acute Stroke Patients for Obstructive Sleep Apnea

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Millene R Camilo ◽  
Heidi H Sander ◽  
Alan L Eckeli ◽  
Regina M Fernandes ◽  
Taiza E Santos-Pontelli ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Acute Stroke ◽  
Predictive Value ◽  
Screening Tools ◽  
Berlin Questionnaire ◽  
Stroke Patients ◽  
Obstructive Sleep ◽  
The Mean

Background: Obstructive sleep apnea (OSA) is frequent in acute stroke patients and is associated with increased mortality and poor functional outcome. Polysomnography (PSG) is the gold standard diagnostic method for OSA, but it is impracticable as a routine for all acute stroke patients. We evaluated how OSA screening tools such as the Berlin Questionnaire (BQ) and the Epworth Sleepiness Scale (ESS) would perform when administered to relatives of stroke patients in the acute setting, and compared these individual tools against a combined screening score (SOS score). Methods: Ischemic stroke patients were submitted to a full PSG at the first night after symptoms onset. OSA severity was measured by apnea-hypopnea index (AHI). BQ and ESS were administered to relatives of stroke patients before the PSG. We combined elements of the BQ and ESS to create a new screening tool for OSA named Sleep Obstructive apnea score optimized for Stroke (SOS score). Results: Thirty-nine consecutives ischemic stroke patients were enrolled in our study. The mean age was 62.3 ±12.2 years. Age was significantly different between those with and without OSA (p=0.02). The mean body mass index and neck circumference were 26.7 ± 4.7 and 38.9 ± 4.0cm, respectively. OSA (AHI ≥ 10) was present in 76.9%. The area under the curve for SOS score (AUC:0.812; p=0.005) was superior to BQ (AUC:0.567; p=0.549) and also to ESS (AUC:0.646; p=0.119 vs. AUC:0.686; p=0.048) for severe OSA (IAH ≥ 30). The threshold of SOS ≤ 10 (present in 20.5% of patients) showed high sensitivity (90%) and negative predictive value (96.2%) for OSA; SOS ≥20 (17.9% of patients) showed high specificity (100%) and positive predictive value (92.5%) for severe OSA. Using SOS as a screening approach would decrease by around 40% the demand for PSG during the acute stroke setting. Conclusions: The SOS score when administered to relatives of stroke patients appears to be an appropriate tool to screen acute stroke patients for OSA, while decreasing the need for a formal sleep study during the acute stroke setting. The new derived SOS score is superior to BQ and ESS for identifying patients with OSA and Severe OSA during the acute phase of stroke.

Diagnostic Accuracy of a Bedside Screening Tool for Dysphagia (BSTD) in Acute Stroke Patients

2021 ◽  
Vol 30 (2) ◽  
pp. 105470
Author(s):  
Paolo Immovilli ◽  
Eugenia Rota ◽  
Nicola Morelli ◽  
Elena Marchesi ◽  
Chiara Terracciano ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Acute Stroke ◽  
Screening Tool ◽  
Stroke Patients
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