title: Speech-language pathologist-led fiberoptic endoscopic evaluation of swallowing: functional outcomes for patients after stroke.
abstract: BACKGROUND
  Dysphagia is a common complication after stroke and is associated with the development of pneumonia. Early detection of dysphagia and specifically aspiration is, therefore, critical in the prevention of pneumonia. Fiberoptic endoscopic evaluation of swallowing (FEES) is a safe bedside instrumental tool for detecting dysphagia and aspiration and, therefore, has the potential to inform dysphagia management. This study investigated the clinical utility of a speech-language pathologist-led FEES service on functional outcomes for patients after acute stroke.
  
  
  METHODS
  A retrospective file audit was carried out on 220 patients before FEES was introduced and on 220 patients after the implementation of a speech-language pathologist-led FEES service. The primary outcome measure was incidence of pneumonia, and secondary outcome measures included mortality, diet on discharge, discharge destination, duration nil-by-mouth, incidence of nonoral feeding, and length of stay.
  
  
  RESULTS
  There was a significant increase in instrumental assessment use in the group that had access to FEES (P < .001). There was a significant reduction of pneumonia rates in the group that had access to FEES (P = .037). Patients were also significantly more likely to leave hospital on standard diets (P = .004) but had longer periods of nonoral feeding (P = .013) and increased length of hospitalization (P < .001).
  
  
  CONCLUSIONS
  When used selectively, FEES services have potential for improving functional outcomes for patients after stroke.
authors.affiliation: Department of Speech Science, The University of Auckland, Auckland, New Zealand.
authors.forename: Louise
authors.initials: L
authors.lastname: Bax
authors.affiliation: Waitemata District Health Board, Westlake, New Zealand; Department of Speech and Language Therapy, Northwick Park Hospital, Harrow, UK.
authors.forename: Mary
authors.initials: M
authors.lastname: McFarlane
authors.affiliation: Department of Speech Science, The University of Auckland, Auckland, New Zealand.
authors.forename: Emma
authors.initials: E
authors.lastname: Green
authors.affiliation: Department of Speech Science, The University of Auckland, Auckland, New Zealand. Electronic address: a.miles@auckland.ac.nz.
authors.forename: Anna
authors.initials: A
authors.lastname: Miles
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D004724:Endoscopy; D004739:England / Q000453:epidemiology; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D013066:Speech-Language Pathology / Q000379:methods*; D020521:Stroke / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors
keywords: Fibreoptic endoscopic evaluation of swallowing; aspiration; dysphagia; pneumonia