title: Postacute reevaluation may prevent Dysphagia-associated morbidity.
abstract: OBJECTIVE
  Accurate identification and tailored management of patients with dysphagia is necessary to prevent complications when dysphagia is present and avoid implications of dietary restriction when unnecessary. Methods of dysphagia assessment vary, and a reassessment in the postacute period is not an established standard. The aim of this retrospective study was to compare initial dysphagia assessment with dysphagia reassessment results for stroke patients admitted to our inpatient rehabilitation facility.
  
  
  METHODS
  We examined medical records of 226 acute stroke patients admitted to our inpatient rehabilitation facility from December 2006 to May 2007. We excluded 86 subjects, then noted the presence or absence of dysphagia based on documentation and prescribed diet and management strategies in the remaining 146 records.
  
  
  RESULTS
  Dysphagia was identified in 94 patients (64%) assessed at our facility. Of these patients, 11% (n=10) were not previously identified in acute care (nonnegligible number, P<0.0001). Agreement regarding presence or absence of dysphagia occurred in 85%. However, prescribed diet differed in 51% (n=75), with 12% (n=18) requiring diet downgrades on admission for rehabilitation.
  
  
  CONCLUSIONS
  The necessity of dysphagia reassessment as part of routine postacute stroke rehabilitation care is not completely established. Our study supports the need for postacute reassessment as 11% of patients with dysphagia would not have been identified without reassessment and 12% required diets more conservative than prescribed in acute care. Prospective research addressing dysphagia specific outcomes is warranted to develop efficient and high-quality standards for preventing poststroke dysphagia associated morbidity.
authors.affiliation: Kessler Foundation, West Orange, NJ, USA. kheckert@gmail.com
authors.forename: Kimberly D
authors.initials: KD
authors.lastname: Heckert
authors.forename: Eugene
authors.initials: E
authors.lastname: Komaroff
authors.forename: Uri
authors.initials: U
authors.lastname: Adler
authors.forename: Anna M
authors.initials: AM
authors.lastname: Barrett
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011788:Quality of Life; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology*; D000071939:Stroke Rehabilitation