Towards a basic endoscopic assessment of swallowing in acute stroke - development and evaluation of a simple dysphagia score.
OBJECTIVE
Dysphagia is an important complication of acute stroke with a reported incidence of up to 76%. The purpose of this investigation was to develop and to evaluate an endoscopic scoring system which has the potential to guide dysphagia management in acute stroke patients.


METHODS
A fiberoptic endoscopic evaluation of swallowing (FEES) was carried out in 100 patients within 72 h of stroke onset. During endoscopic examination, the secretion status was evaluated, and the patient was successively given standard volumes of puree consistency, liquids and soft solid food. Penetration and aspiration was assessed using a 5-point scale.


RESULTS
Nearly 80% of patients showed penetration or aspiration during FEES. These events occurred more frequently with liquids and soft solid food than with puree. Penetration or aspiration at any stage of examination predicted failure at the subsequent food consistency. Furthermore, key findings of endoscopic evaluation were predictive of the need for later orotracheal intubation. Based on these observations a score was developed that grades stroke-related dysphagia according to the risk of penetration or aspiration of the different food consistencies tested. Assessment of interrater reliability by means of 25 additional endoscopic examinations resulted in excellent agreement between three investigators, reflected by a kappa coefficient of 0.89.


CONCLUSIONS
Stroke-related dysphagia may effectively be graded using a simple endoscopic scoring system. The usefulness of this screening protocol with respect to patient outcome and intercurrent complications has to be studied in prospective clinical trials.
Department of Neurology, University Hospital of Munster, Munster, Germany. dziewas@uni-muenster.de
Rainer
R
Dziewas
Tobias
T
Warnecke
Stefan
S
Olenberg
Inga
I
Teismann
Julian
J
Zimmermann
Christoffer
C
Kramer
Martin
M
Ritter
E Bernd
EB
Ringelstein
Wolf R
WR
Schabitz
D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003680:Deglutition Disorders / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D007442:Intubation, Intratracheal; D007828:Laryngoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D053120:Respiratory Aspiration / Q000209:etiology* / Q000503:physiopathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D020521:Stroke / Q000150:complications* / Q000503:physiopathology