Article

Despite the availability of multiple comprehensive screening methods
to detect dysphagia during acute stroke care, consensus is lacking as to the best
practice. Our previous study demonstrated favorable sensitivity of the Functional
Independence Measure (FIM) compared with a bedside 3-sip test. However, the FIM
is challenging to administer during acute stroke care. The National Institutes of
Health Stroke Scale (NIHSS) is administered routinely in the emergency
department. OBJECTIVE: To evaluate the utility of the NIHSS as a predictor of
clinically relevant poststroke dysphagia compared with FIM data in the same
cohort. DESIGN: Retrospective analysis. SETTING: Academic medical center.
PATIENTS: Individuals with acute stroke who were admitted for acute care and
later transferred to acute rehabilitation within the same institution. METHODS:
Clinically relevant dysphagia was defined as aspiration on modified barium
swallow or laryngeal penetration on modified barium swallow requiring diet
change, or aspiration pneumonia. NIHSS and FIM scores were compiled for all
patients. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, positive
predictive value, and negative predictive value were calculated for NIHSS and
FIM. Sensitivity and specificity of different values of NIHSS and FIM were
analyzed via receiver operator characteristic curves.
RESULTS: Of 290 patients
admitted to acute stroke rehabilitation, 88 (30%) manifested clinically relevant
dysphagia during their rehabilitation stay. Sensitivity analyses suggested
cut-off values for the NIHSS and the FIM of >9 and <55, respectively.
Sensitivity, specificity, positive predictive value, and negative predictive
value for the NIHSS were 75%, 62%, 46%, and 85%, respectively. For the FIM, these
parameters were 80%, 72%, 55%, and 92%, respectively. CONCLUSIONS: The NIHSS >9
and FIM <55 are moderately predictive of clinically relevant dysphagia. Although
the NIHSS clinical test characteristics are not as favorable as the FIM, NIHSS
appears to be more sensitive than some other reported methods such as a 3-sip
water test. Further study into development of paradigms that incorporate NIHSS
into initial assessment of dysphagia risk may be appropriate.
CI - Copyright (c) 2015 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS