Screening for Silent Aspiration in Hyperacute Stroke: A Feasibility Study of Clinical Swallowing Examination and Cough Reflex Testing

Autor/inn/en	Trimble, Julie; Patterson, Joanne M.; Wilson, Janet A.; Dixit, Anand K.; Drinnan, Michael
Titel	Screening for Silent Aspiration in Hyperacute Stroke: A Feasibility Study of Clinical Swallowing Examination and Cough Reflex Testing
Quelle	In: International Journal of Language & Communication Disorders, 58 (2023) 5, S.1657-1667 (11 Seiten) PDF als Volltext Verfügbarkeit
Zusatzinformation	ORCID (Trimble, Julie)
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	1368-2822
DOI	10.1111/1460-6984.12893
Schlagwörter	Screening Tests; Neurological Impairments; Human Body; Eating Disorders; Diseases; Speech Language Pathology; Motor Reactions; Foreign Countries; Patients; Voice Disorders; United Kingdom (Newcastle upon Tyne) + Suchen Sie Ihr Suchwort? Screening-Verfahren; Neurodegenerative Erkrankung; Menschlicher Körper; Appetite disorder; Essstörung; Disease; Krankheit; Ausland; Patient; Stimmstörung
Abstract	Background: Silent aspiration (SA) is common post-stroke and associated with increased risk of pneumonia, length of stay and healthcare costs. Clinical swallow examinations (CSEs) are unreliable measures of SA. There is no consensus on the clinical components that best detect SA. Cough reflex testing (CRT) is an alternative/adjunct whose SA detection accuracy also lacks consensus. Aims: To investigate the feasibility of CSE versus CRT against gold standard flexible endoscopic evaluation of swallowing (FEES) for SA identification and to estimate its prevalence in a hyperacute stroke setting. Methods & Procedures: A single-arm preliminary, prospective, feasibility study of patients less than 72 h post-stroke, over a 31-day period on a hyperacute stroke unit: the Royal Victoria Infirmary, Newcastle-upon-Tyne, UK. Ethical approval for the study was obtained. The study tested the feasibility and acceptability of introducing CRT and developing a standardized CSE. Consent/assent was obtained for all participants. Patients unfit for study were excluded. Outcomes & Results: A total of 62% of patients less than 72 h post-stroke (n = 61) were eligible. A total of 75% of those approached (n = 30) consented. A total of 23 patients completed all tests. The principal barrier was anxiety regarding FEES. Mean test time for CRT = 6 min; CSE = 8 min; FEES = 17 min. Patients rated CRT and FEES on average as moderately uncomfortable. A total of 30% (n = 7) of participants who received FEES presented with SA. Conclusions & Implications: CRT, CSE and FEES are feasible in 58% of hyperacute stroke patients in this setting. FEES anxiety is the main recruitment barrier and is not always well tolerated. Results support further work to establish optimum methods and differential sensitivity/specificity of CRT and CSE in hyperacute stroke for SA identification. (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2024/1/01