The simple and fast swallowing function assessment in acute stroke patients

Abstract

OBJECTIVE: The dysphagia associated pulmonary aspiration is one of the important reasons for mortality and morbidity instroke. In this study, we evaluated the early swallowing functions of the acute ischemic stroke patients, and tried to choosethe right way to start feeding with simple tests.METHODS: Seventy-three inpatients with acute stroke were included in this study. Age, gender, type of stroke, NIHSSand RANKIN scores, risk of aspiration and feeding route were recorded for all the subjects. Dysphagia was evaluated withthe bedside clinical evaluation of swallowing function score (BDS) tests. These BDS tests are the assessment of dysphagiawith neurological examination score (DSNE) and the bedside water drinking test (BWT) and the Swallowing score (SS)ratio (combining BWT and DSNE scores). All tests to evaluate swallowing were planned to be carried out 24 hours after thelast known time of the patient’s healthy and 48 hours after hospitalized. The tests were performed in awake patients whowere able to manage to cooperate at the scheduled time. In addition, stroke patients were evaluated quantitatively usingthe Gugging Swallowing Screen (GUSS) test for dysphagia and compared with BDS tests. All patients were evaluated foraspiration pneumonia seven days after admission. If the patients had drowsiness or were unable to cooperate, they werenot included in this study.RESULTS: Seventy-three (26F/47M) patients were included in this study if they were conscious and the Glasgow coma scalewas above 10 points. When only BDS tests were performed, we decided that 74% (n=54) of the patients could be fed by theoral route, 13.7% of the patients could be fed only by NG route (n=10) and the patients who had the worst BWT and DSNEscores preferred to be feed with PEG route (11% of all the patients, n=8). In 41.1% of the patient (n=30) established therisk of aspiration on referral clinic and 23.3% of the patients (n=17) developed aspiration pneumonia in the clinical follow-up.When 30.1% (22) of the patients had dysphagia with GUSS test, 23.3% (n=17) of the patients were dysphagic with DSNEand 30.1% of the patients (n=22) were dysphagic with BWT and 22% (n=16) of the patients were moderate-severe, 11%(n=8) of the patients were mild dysphagic with the SS ratio.CONCLUSION: These BDS tests concluded are fast and reliable methods for evaluating the dysphagia and risk of aspirationpneumonia without laborious and very few clinically applicable methods, such as endoscopic or video fluoroscopy, in patientswho are hospitalized with stroke.