Incidence of Dysphagia in Acute Stroke Patients: An Early Screening and Management
Susan P Chacko, Anagha A Joshi, Vaishnavi R Sangle, Devika S Arora, Rishidhar A Dubey
Dysphagia, FEES, Swallowing therapy
Citation Information :
Chacko SP, Joshi AA, Sangle VR, Arora DS, Dubey RA. Incidence of Dysphagia in Acute Stroke Patients: An Early Screening and Management. Int J Phonosurg Laryngol 2021; 11 (2):50-53.
Introduction: In acute stroke dysphagia is a common complication associated with a risk of pneumonia and mortality. The primary aim of our study was to assess the incidence of dysphagia in acute stroke patients and analyze the benefits of early screening and management.
Materials and methods: A prospective cohort study was conducted in our center. A total of 100 acute stroke patients were seen. All patients were then assessed by Mann assessment of swallowing ability (MASA) for the presence of dysphagia and aspiration. Patients with dysphagia were then further evaluated by fiber-optic-endoscopic evaluation of swallowing (FEES), stroke severity was assessed by National Institutes of Health Stroke Scale (NIHSS) score and location of stroke was done on the basis of CT scan of the brain.
Results: Dysphagia was seen in 53 patients of acute stroke. FEES and swallowing therapy were done in 39 of dysphagia patients. The 3 parameters considered in FEES were penetration aspiration scale, secretion rating scale and residue rating scale. In patients with mild dysphagia compensatory strategies were given whereas in patients with moderate to severe dysphagia both compensatory and rehabilitative were given. Improvement was seen in our patients after swallowing therapy.
Conclusion: The incidence of dysphagia in acute stroke patients was 53%. MASA scale helped in early detection of dysphagia. FEES and appropriate swallowing therapy played a significant role in improving the outcome of our patients.
Kwon S, Sim J, Park J, et al. Assessment of aspiration risk using the Mann Assessment of Swallowing Ability in brain-injured patients with cognitive impairment. Front Neurol 2019;10:1264. DOI: 10.3389/fneur.2019.01264
Mann G. MASA, the Mann Assessment of Swallowing Ability. Cengage Learning; 2002.
Lim SH, Lieu PK, Phua SY, et al. Accuracy of bedside clinical methods compared with fiberoptic endoscopic examination of swallowing (FEES) in determining the risk of aspiration in acute stroke patients. Dysphagia 2001(Winter);16(1):1–6. DOI: 10.1007/s004550000038
Rosenbek JC, Robbins JA, Roecker EB, et al. A penetration-aspiration scale. Dysphagia 1996;11:93–98. DOI: 10.1007/BF00417897
Miles A, Hunting A, McFarlane M, et al. Predictive value of the New Zealand Secretion Scale (NZSS) for pneumonia. Dysphagia 2018;33(1):115–122. DOI: 10.1007/s00455-017-9841-z
Neubauer PD, Rademaker AW, Leder SB. The Yale pharyngeal residue severity rating scale: an anatomically defined and image-based tool. Dysphagia 2015;30:521–528. DOI: 10.1007/s00455-015-9631-4
Falsetti P, Acciai C, Palilla R, et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis Off J Natl Stroke Assoc 2009;18: 329–335. DOI: 10.1016/j.jstrokecerebrovasdis.2009.01.009
Martino R, Foley N, Bhogal S, et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke J Cereb Circ 2005;36: 2756–2763. DOI: 10.1161/01.STR.0000190056.76543.eb
Arnold M, Liesirova K, Broeg-Morvay A, et al. Dysphagia in acute stroke: incidence, burden and impact on clinical outcome. PLoS One 2016;11(2):e0148424. DOI: 10.1371/journal.pone.0148424
Okubo PCMI, Fábio SRC, Domenis DR, et al. Using the National Institute of Health Stroke Scale to predict dysphagia in acute ischemic stroke. Cerebrovasc Dis 2012;33: 501–507. DOI: 10.1159/000336240
Walter U, Knoblich R, Steinhagen, V, et al. Predictors of pneumonia in acute stroke patients admitted to a neurological intensive care unit. J Neurol 2007;254:1323. DOI: 10.1007/s00415-007-0520-0
Upadya A, Thorevska N, Sena KN, et al. Predictors and consequences of pneumonia in critically ill patients with stroke. J Crit Care 2004;19(1):16–22. DOI: 10.1016/j.jcrc.2004.02.004