Flexible endoscopic evaluation of swallowing vs. screening tests for dysphagia and their effect on the final outcome in post-acute stroke patients

Česká verze

Authors: G. Solná ¹; D. Václavík ^1,2; O. Pavlík ¹; B. Gwardová ¹; L. Staníková ³ ; Pavel Komínek ^3,4
Authors place of work: Vzdělávací a výzkumný institut Agel, o. p. s., Neurologické oddělení, Vítkovická nemocnice, a. s., Ostrava ¹; Katedra neurologie, LF OU, Ostrava ²; Klinika otorinolaryngologie a chirurgie hlavy a krku FN Ostrava ³; Katedra kraniofaciálních oborů, LF OU, Ostrava ⁴
Published in the journal: Cesk Slov Neurol N 2020; 83/116(6): 614-620
Category: Původní práce
doi: https://doi.org/10.48095/cccsnn2020614

Summary

Aim: Dysphagia is a common and often severe stroke complication. Dysphagia screening is used to detect presence of dysphagia in post stroke patients in the Czech Republic. The Gugging Swallowing Screen (GUSS) is the most common method. Flexible Endoscopic Evaluation of Swallowing (FEES) is another objective method capable of detecting dysphagia. Aim of this study was to correlate results of GUSS and FEES and to evaluate the impact of FEES on functional outcomes in stroke patients.

Patients and methods: 100 patients with acute stroke were randomized in two groups, 50 patients were tested with GUSS and FEES, and 50 patients only with GUSS. Death, dysphagia severity, severity of neurological deficit, and disability status were followed up to 30 days.

Results: 47 men and 53 women (mean age 71.2 years) were included in the study. We did not find any significant difference in deaths, length of hospitalizations, dysphagia severity, and pneumonia incidence between both groups. Correlation coefficient between GUSS and FEES screening was 0.8. In the FEES group, we adjusted the diet according to the FEES results in 20% of patients; in this group we found significantly lower respiratory infection incidence (P = 0.045).

Conclusion: Testing patients with FEES did not lead to better functional outcome after stroke in our patients. We lowered respiration infection incidence by adjusting the diet according to the FEES results.

Keywords:

dysphagia – screening – The Gugging Swallowing Screen – flexible endoscopic evaluation

Zdroje

1. Škoda O, Herzig R, Mikulík R et al. Klinický standard pro diagnostiku a léčbu pacientů s ischemickou cévní mozkovou příhodou a s tranzitorní ischemickou atakou – verze 2016. Cesk Slov Neurol N 2016; 79/112 (3): 351–363. doi: 10.14735/amcsnn2016351

2. Scottish Intercollegiate Guidelines Network (SIGN) (2010): Management of patients with stroke: identification and management of dysphagia. A national clinical guideline. [online]. Available from URL: http: //www.sign.ac.uk.

3. Martino R, Foley N, Bhogal S et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36 (12): 2756–2763. doi: 10.1161/01.STR.0000190056.76543.eb.

4. Smith CH, Logemann JA, Colangelo LA et al. Dysphagia. Incidence and patient characteristics associated with silent aspiration in the acute care setting. Dysphagia 1999; 14 (1): 1–7. doi: 10.1007/PL00009579.

5. Solná G, Lasotová N, Lebedová Z et al. Návrh jednotného postupu v péči o pacienty s dysfagií na iktových jednotkách v ČR. [online]. Dostupné z URL: http: //nemocnicevitkovice.agel.cz/pracoviste/oddeleni/neurologicke-oddeleni/pdf/pece-o-pac-dysfagie.pdf.

6. Václavík D, Solná G, Lasotová N et al. Standard léčebného plánu – Péče o pacienty s dysfagií po cévní mozkové příhodě. Cesk Slov Neurol N 2015; 78/111 (6): 721–727. doi: 10.14735/amcsnn2015721.

7. Trapl M, Enderle P, Nowotny M et al. Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen. Stroke 2007; 38 (11): 2948–2952. doi: 10.1161/STROKEAHA.107.483933.

8. Solná G, Václavík D, Lasotová N et al. Péče o pacienty po cévní mozkové příhodě v České republice. Cesk Slov Neurol N 2018; 81 (5): 528–531. doi: 10.14735/amcsnn2018528.

9. Warnecke T, Im S, Kaiser C et al. Aspiration and dysphagia screening in acute stroke – the Gugging Swallowing Screen revisited. Eur J Neurol 2017; 24 (4): 594–601. doi: 10.1111/ene.13251.

10. Lasotová N. Screening dysfagie GUSS. [online]. Dostupné z URL: http: //www.fnbrno.cz/nemocnice-bohunice/neurologicka-klinika/screening-dysfagie-guss/t4943.

11. Rosenbek JC, Robbins JA, Roecker EB et al. A penetration-aspiration Scale. Dysphagia 1996; 11 (2): 93–98. doi: 10.1007/BF00417897.

12. Kolek V, Kolář M, Kašák V et al. [online]. Dostupné z URL: https: //www.infekce.cz/Legislativa/Pneumonie%20DP170311.pdf.

13. Smith CJ, Kishore AK, Vail A et al. Diagnosis of stroke-associated pneumonia: recommendations from the Pneumonia in Stroke Consensus Group. Stroke 2015; 46 (8): 2335–2340. doi: 10.1161/STROKEAHA.115.009617.

14. Powers WJ, Rabinstein AA, Ackerson T et al. 2018 guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018; 49 (3): e46–110. doi: 10.1161/STR.0000000000000158.

15. Smith EE, Kend DM, Bulsara KR et al. Effect of dysphagia screening strategies on clinical outcomes after stroke: a systematic review for the 2018 guidelines for the early management of patients with acute ischemic stroke. Stroke 2018; 49 (3): e123–128. doi: 10.1161/STR.0000000000000159.

16. Al-Khaled M, Matthis C, Binder A et al. Dysphagia in patients with acute ischemic stroke: early dysphagia screening may reduce stroke-related pneumonia and improve stroke outcomes. Cerebrovasc Dis 2016; 42 (1–2): 81–89.

17. Joundi RA, Martino R, Saposnik G et al. Predictors and outcomes of dysphagia screening after acute ischemic stroke. Stroke 2017; 48 (4): 900–906. doi: 10.1161/STROKEAHA.116.015332.

18. Hinchey JA, Shephard T, Furie K et al. Formal dysphagia screening protocols prevent pneumonia. Stroke 2005; 36 (9): 1972–1976. doi: 10.1161/01.STR.000017 7529.86868.8d.

19. Palli CH, Fandler S, Doppelhofer K et al. Early dysphagia screening by trained nurses reduces pneumonia rate in stroke patients: a clinical intervention study. Stroke 2017; 48 (9): 2583–2585. doi: 10.1161/STROKEAHA.117.018157.

20. Martino R, Foley N, Bhogal S et al. Dysphagia after stroke: incidence, diagnosis, and pulmonary complications. Stroke 2005; 36 (12): 2756–63. doi: 10.1161/01.STR.0000190056.76543.eb.

21. Arnold M, Liesirova K, Broeg-Morvay A et al. Dysphagia in Acute Stroke: Incidence, Burden and Impact on Clinical Outcome. PloS One 2016; 11 (2): e0148424. doi: 10.1371/journal.pone.0148424.

22. Kishore AK, Vail A, Chamorro A et al. How is pneumonia diagnosed in clinical stroke research? A systematic review and meta-analysis. Stroke 2015; 46 (5): 1202–1209. doi: 10.1161/STROKEAHA.114.007843.

23. Falsetti P, Acciai C, Palilla R et al. Oropharyngeal dysphagia after stroke: incidence, diagnosis, and clinical predictors in patients admitted to a neurorehabilitation unit. J Stroke Cerebrovasc Dis 2009; 18 (5): 329–335. doi: 10.1016/j.jstrokecerebrovasdis.2009.01.009.

24. Westendorp WF, Nederkoorn PJ, Vermeij J-D et al. Post-stroke infection: a systematic review and meta--analysis. BMC Neurol 2011; 11: 110. doi: 10.1186/1471-2377-11-110.

25. Teuschl Y, Trapl M, Ratajczak P et al. Systematic dysphagia screening and dietary modifications to reduce stroke-associated pneumonia rates in a stroke-unit. PLoS One 2018; 13 (2): e0192142. doi: 10.1371/journal.pone.0192142.

26. Bray BD, Smith CJ, Cloud GC et al. The association between delays in screening for and assessing dysphagia after acute stroke, and the risk of stroke-associated pneumonia. J Neurol Neurosurg Psychiatry 2017; 88 (1): 25–30. doi: 10.1136/jnnp-2016-313356.

27. Masrur S, Smith EE, Saver JL et al. Dysphagia screening and hospital-acquired pneumonia in patients with acute ischemic stroke: findings from Get with the Guidelines–Stroke. J Stroke Cerebrovasc Dis 2013; 22 (8): e301–309. doi: 10.1016/j.jstrokecerebrovasdis.2012.11.013.

28. Dziewas R. ESO guidelines on stroke & dysphagia. Proceedings of the 4th European Stroke Organisation Conference, 2018, Gothenburg, Sweeden.