title: Predicting prolonged dysphagia in acute stroke: the Royal Adelaide Prognostic Index for Dysphagic Stroke (RAPIDS).
abstract: Dysphagia is common after stroke and is associated with increased morbidity and mortality. Predicting those who are likely to have significant prolonged dysphagia is not possible at present. This study was undertaken to validate the Royal Adelaide Prognostic Index for Dysphagic Stroke (RAPIDS) in the prediction of prolonged dysphagia following acute stroke using clinical and radiographic features. A prospective study of unselected, consecutive admissions to the Royal Adelaide Hospital acute stroke unit was undertaken. Clinical and radiographic features applicable to the RAPIDS test were calculated and the sensitivity, specificity, and likelihood ratio for predicting prolonged dysphagia were calculated with 95% confidence intervals (CI). Of 104 subjects admitted with acute stroke, 55 (53%) had dysphagia and 20 (19%) had dysphagia requiring nonoral feeding/hydration for 14 days or more or died while dysphagic prior to 14 days. The RAPIDS test had sensitivity of 90% (95% CI = 70-97%) and specificity of 92% (95% CI - 84-96%) for predicting this latter group of patients. We conclude that the RAPIDS test can be used early to identify patients likely to have prolonged dysphagia. This test could form a basis for selection of patients for trials of nonoral feeding methods.
authors.affiliation: Department of Neurology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia. simon.broadley@griffith.edu.au
authors.forename: Simon
authors.initials: S
authors.lastname: Broadley
authors.forename: Alison
authors.initials: A
authors.lastname: Cheek
authors.forename: Susie
authors.initials: S
authors.lastname: Salonikis
authors.forename: Emma
authors.initials: E
authors.lastname: Whitham
authors.forename: Victoria
authors.initials: V
authors.lastname: Chong
authors.forename: David
authors.initials: D
authors.lastname: Cardone
authors.forename: Basile
authors.initials: B
authors.lastname: Alexander
authors.forename: James
authors.initials: J
authors.lastname: Taylor
authors.forename: Philip
authors.initials: P
authors.lastname: Thompson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000534:rehabilitation; D003955:Diagnostic Tests, Routine / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications*; D000071939:Stroke Rehabilitation; D013997:Time Factors