title: Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: nursing admission screening tool versus National Institutes of Health stroke scale.
abstract: This study assessed the positive and negative predictive values and the sensitivity and specificity of a nursing dysphagia screening tool and the National Institutes of Health Stroke Scale (NIHSS) for the identification of dysphagia for veterans hospitalized with ischemic stroke.A secondary objective of this study was to evaluate the speech-language pathology consult rate before and after the nursing admission dysphagia screening tool. This retrospective cohort study evaluated veterans admitted to one Department of Veterans Affairs medical center with ischemic stroke during the 6 months both before and after the implementation of a nursing dysphagia screening tool, which was part of the admission nursing template. Stroke severity was measured with the use of the retrospective NIHSS. Dysphagia diagnosis was based on speech-language pathology evaluations.Dysphagia was present in 38 of 101 patients (38%) with ischemic stroke. The nursing dysphagia screening tool had a positive predictive value of 50% and a negative predictive value of 68%, with a sensitivity of 29% and specificity of 84%. The use of the NIHSS to identify dysphagia risk had a positive predictive value of 60% and a negative predictive value of 84%.The NIHSS had better test characteristics in predicting dysphagia than the nursing dysphagia screening tool. Future research should evaluate the use of the NIHSS as a screening tool for dysphagia.
authors.affiliation: Richard L. Roudebush VA Medical Center, Center of Excellence on Implementing Evidence-Based Practice, HSR&D (11H), 1481 W 10th Street, Indianapolis, IN 46202, USA. dbravata@iupui.edu
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Bravata
authors.forename: Virginia S
authors.initials: VS
authors.lastname: Daggett
authors.forename: Heather
authors.initials: H
authors.lastname: Woodward-Hagg
authors.forename: Teresa
authors.initials: T
authors.lastname: Damush
authors.forename: Laurie
authors.initials: L
authors.lastname: Plue
authors.forename: Scott
authors.initials: S
authors.lastname: Russell
authors.forename: George
authors.initials: G
authors.lastname: Allen
authors.forename: Linda S
authors.initials: LS
authors.lastname: Williams
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Harezlak
authors.forename: Neale R
authors.initials: NR
authors.lastname: Chumbler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology* / Q000451:nursing; D003955:Diagnostic Tests, Routine; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009316:National Institutes of Health (U.S.); D009730:Nursing Assessment; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D014481:United States