Edmiaston Jeff, Connor Lisa Tabor, Steger-May Karen, Ford Andria L
Department of Rehabilitation, Barnes-Jewish Hospital, St Louis, Missouri.
Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri; Department of Radiology, Washington University School of Medicine, St Louis, Missouri; Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
J Stroke Cerebrovasc Dis. 2014 Apr;23(4):712-6. doi: 10.1016/j.jstrokecerebrovasdis.2013.06.030. Epub 2013 Jul 30.
Early identification of dysphagia is associated with lower rates of pneumonia after acute stroke. The Barnes-Jewish Hospital Stroke Dysphagia Screen (BJH-SDS) was previously developed as a simple bedside screen performed by nurses for sensitive detection of dysphagia and was previously validated against the speech pathologist's clinical assessment for dysphagia. In this study, acute stroke patients were prospectively enrolled to assess the accuracy of the BJH-SDS when tested against the gold standard test for dysphagia, the videofluoroscopic swallow study (VFSS).
Acute stroke patients were prospectively enrolled at a large tertiary care inpatient stroke unit. The nurse performed the BJH-SDS at the bedside. After providing consent, patients then underwent VFSS for determination of dysphagia and aspiration. The VFSS was performed by a speech pathologist who was blinded to the results of the BJH-SDS. Sensitivity and specificity were calculated. Pneumonia rates were assessed across the 5-year period over which the BJH-SDS was introduced into the stroke unit.
A total of 225 acute stroke patients were enrolled. Sensitivity and specificity of the screen to detect dysphagia were 94% and 66%, respectively. Sensitivity and specificity of the screen to detect aspiration were 95% and 50%, respectively. No increase in pneumonia was identified during implementation of the screen (P = .33).
The BJH-SDS, validated against videofluoroscopy, is a simple bedside screen for sensitive identification of dysphagia and aspiration in the stroke population.
急性卒中后早期识别吞咽困难与较低的肺炎发生率相关。巴恩斯-犹太医院卒中吞咽困难筛查（BJH-SDS）先前被开发为一种由护士在床边进行的简单筛查方法，用于敏感检测吞咽困难，并且先前已针对言语病理学家的吞咽困难临床评估进行了验证。在本研究中，前瞻性纳入急性卒中患者，以评估BJH-SDS与吞咽困难的金标准测试——视频荧光吞咽造影检查（VFSS）相比时的准确性。
在一家大型三级护理住院卒中单元前瞻性纳入急性卒中患者。护士在床边进行BJH-SDS。在患者签署知情同意书后，然后接受VFSS以确定是否存在吞咽困难和误吸。VFSS由一名对BJH-SDS结果不知情的言语病理学家进行。计算敏感性和特异性。在将BJH-SDS引入卒中单元的5年期间评估肺炎发生率。
共纳入225例急性卒中患者。该筛查检测吞咽困难的敏感性和特异性分别为94%和66%。该筛查检测误吸的敏感性和特异性分别为95%和50%。在实施该筛查期间未发现肺炎发生率增加（P = 0.33）。
经视频荧光造影检查验证的BJH-SDS是一种用于敏感识别卒中人群吞咽困难和误吸的简单床边筛查方法。
