title: [Management of dysphagia in acute stroke : A prospective study for validation of current recommendations].
abstract: BACKGROUND
  The German expert recommendations on the management of dysphagia in patients after acute stroke suggest an algorithm for clinical and technical investigations to identify patients at risk for aspiration and thus reduce the rate of aspiration pneumonia. The effectiveness of this algorithm has, however, not yet been prospectively validated .
  
  
  METHODS
  In this study 144 consecutive stroke patients were assessed by a full bedside swallowing assessment including the screening procedures of standardized swallowing assessment (SSA) and 2 out of 6. Flexible endoscopic evaluation of swallowing (FEES) was performed in all patients.
  
  
  RESULTS
  Aspiration was diagnosed in 25 patients (17.4%) by FEES. The SSA predicted aspiration with a sensitivity of 76% and a specificity of 55.5% and the 2 out of 6 screening with a sensitivity of 68.0% and a specificity of 61.0%. Of the patients 7 with negative screening for 2 out of 6 and 6 patients with negative SSA showed silent aspiration with the penetration aspiration scale (PAS 8) during FEES (28% of all patients with aspiration). Significant predictors for aspiration were dysarthria, dysphonia, abnormal volitional cough and cough after swallowing water; however, in multivariable analysis only dysarthria and cough after swallowing water were identified as independent predictors for aspiration. The rate of aspiration pneumonia was 2.8%.
  
  
  CONCLUSIONS
  Clinical screening alone is not sufficient to identify patients at risk for aspiration pneumonia. The FEES should be used at a low threshold in cases of severe stroke and minor clinical abnormalities, especially concerning isolated dysarthria and cough after swallowing water; therefore, current recommendations should be correspondingly modified.
authors.affiliation: Logopädie, Universitäts- und Rehabilitationskliniken Ulm (RKU), Oberer Eselsberg 45, 89081, Ulm, Deutschland. beate.lindner-pfleghar@rku.de.
authors.forename: B
authors.initials: B
authors.lastname: Lindner-Pfleghar
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Ulm, Ulm, Deutschland.
authors.forename: H
authors.initials: H
authors.lastname: Neugebauer
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Ulm, Ulm, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Stösser
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Ulm, Ulm, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Kassubek
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Ulm, Ulm, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Ludolph
authors.affiliation: Klinik für Neurologie, Universitätsklinikum Münster, Münster, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Dziewas
authors.affiliation: , München, Deutschland.
authors.forename: M
authors.initials: M
authors.lastname: Prosiegel
authors.affiliation: Klinik für Neurologie und Rehabilitation, RehaNova GmbH, Köln, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Riecker
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000534:rehabilitation; D005260:Female; D005858:Germany; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D009462:Neurology / Q000592:standards; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications* / Q000175:diagnosis; D000071939:Stroke Rehabilitation / Q000592:standards*; D016896:Treatment Outcome
keywords: Acute stroke; Aspiration; Flexible endoscopic evaluation of swallowing (FEES); Management of dysphagia; Screening