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[Dysphagia] Screening


  • Subject: [Dysphagia] Screening
  • From: eripley at yahoo.com (Irene Campbell-Taylor)
  • Date: Sat Aug 26 06:20:17 2006

NIH Stroke Scale
   
  http://www.strokeassociation.org/downloadable/stroke/5153_HosScale.pdf#search=%22screen%20dysphagia%22
   
  The first part, presumably completed by the admitting physician,  contains the neuro information that should be added to the clinical assessment i.e. extraocular movements, facial nerve damage. Near the end is the dysphagia screening. 
  See:
  Formal Dysphagia Screening Protocols Prevent Pneumonia
  Full text at:
  http://stroke.ahajournals.org/cgi/content/full/36/9/1972
  There are also some useful tidbits at:
  http://www.geronurseonline.org/index.cfm?section_id=7&sub_section_id=11&template_id=9
   
  The whole topic of screening is fraught with problems but people are going to do it anyway. The process described is not actually screening, which applies only to large scale, population based searches for incidence/prevalence of diseases, but brief clinical assessments.
  If you have access to the following journals, these are  not too bad.
          Journal of Clinical Nursing
Volume 10 Page 463  - July 2001


      Screening swallowing function of patients with acute stroke. Part one: identification, implementation and initial evaluation of a screening tool for use by nurses
      Lin Perry MSc, RGN, RNT
      ? Stroke is a major cause of acute and chronic disability in the developed world, producing a wide range of impairments, including dysphagia, which impact upon eating.
  ? Dysphagia affects between one and two thirds of patients with acute stroke, with the potential for life-threatening airway obstruction, aspiration pneumonia and malnutrition.
  ? Whilst associated with increased impairment, dysphagia may present in isolation or accompanied by minimal disability; universal screening of swallowing function is recommended.
  ? This study describes the process undertaken to review the evidence for dysphagia screening methods in patients with acute stroke. It also identifies, implements and establishes sensitivity and specificity of a screening tool (the Standardized Swallowing Assessment, SSA) for use by nurses.
  ? Not all ward staff had completed training to use the SSA by conclusion of the patient audit. Nonetheless 123 out of 165 assessable patients (74.5%) had their swallow function screened, 64 by SSA (52%). Based on 68 completed screening episodes by independently competent nurses, a comparison with summative clinical judgement of swallow function revealed a sensitivity of 0.97 and specificity of 0.9 for detection of dysphagia, with positive and negative predictive values of 0.92 and 0.96. This was significantly better than gag reflex performance, supporting the use of the SSA by competent ward nurses.
      International Nursing Review
Volume 53 Page 143  - June 2006


      Review Article
      Detection of eating difficulties after stroke: a systematic review
      A. Westergren rn, phd
      WESTERGREN A. (2006) Detection of eating difficulties after stroke: a systematic review. International Nursing Review53, 143?149
  Background: It is highly important in nursing care for persons with stroke to screen for, assess and manage eating difficulties. The impact on eating after stroke can be of different types, comprising dysphagia as well as eating difficulties in a larger perspective. Eating difficulties can cause complications such as malnutrition, dehydration, aspiration, suffocation, pneumonia and death. There is a lack of systematic reviews about methods to be used by nurses in their screening for eating difficulties.
  Aim: This review aims at systematically capturing and evaluating current peer-reviewed published literature about non-instrumental (besides pulse oximetry) and non-invasive screening methods for bedside detection of eating difficulties among persons with stroke.
  Methods: A search was performed in Medline and 234 articles were obtained. After a selection process 17 articles remained, covering seven screening methods and including about 2000 patients.
  Conclusion: Best nursing practice for detecting eating difficulties includes as the first step the Standardized Bedside Swallowing Assessment (SSA) to detect dysphagia (strong evidence). As the second step an observation should be made of eating including ingestion, deglutition and energy (moderate evidence). Applying pulse oximetry simultaneously to SSA can possibly add to the accuracy of aspiration detection, especially silent aspiration (limited evidence). The methods should be used as a complement to interviews.
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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www.interactivetherapy.com


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