Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Arch Phys Med Rehabil. 2019 Jul;100(7):1289-1293. doi: 10.1016/j.apmr.2018.12.032. Epub 2019 Jan 23.
The goal was to examine the outcomes of an existing swallow screen protocol in comparison to results from a formal videofluoroscopic protocol.
Prospective cohort study.
Acute hospital.
Patients after acute stroke (N=48).
Not applicable.
The Johns Hopkins Hospital Brain Rescue Unit 3 oz Swallow Screen was implemented by nursing staff upon admission. Videofluoroscopy was conducted within 72 hours of diagnostic neuroimaging and initial swallow screen. Predictive values of the bedside swallow screen (pass/fail) for clinical judgment of dysphagia on videofluoroscopy (presence/absence) were calculated. Overall impairment scores from the Modified Barium Swallowing Impairment Profile were analyzed with respect to swallow screen results.
Thirteen participants failed the swallow screen, and 35 passed. Of the 35 patients who passed the swallow screen, 15 were clinically diagnosed with dysphagia on videofluoroscopy. Although pass/fail of the swallow screen was not a significant predictor of presence/absence of dysphagia, a logistic regression model including components of Laryngeal Elevation, Laryngeal Vestibule Closure, and Anterior Hyoid Excursion, and sex was statistically significant for swallow screen outcome.
The results of this study suggest that a swallow screen of aspiration risk can identify patients with the most need for videofluoroscopic evaluation and dysphagia management. Additionally, patients who fail a swallow screen are more likely to present with physiologic impairments related to airway protection on videofluoroscopy.
本研究旨在比较现有的吞咽筛查方案与正式的视频透视吞咽造影检查（VFSS）结果，以评估现有吞咽筛查方案的效果。
前瞻性队列研究。
急性医院。
急性脑卒中患者（N=48）。
无。
入院时由护理人员实施约翰霍普金斯医院脑复苏单位 3 盎司吞咽筛查，在诊断性神经影像学检查和初始吞咽筛查后 72 小时内进行 VFSS。计算床边吞咽筛查（通过/失败）对 VFSS 上临床判断吞咽困难（存在/不存在）的预测值。采用改良吞咽障碍评估量表（MBSS）的总体损伤评分分析吞咽筛查结果。
13 名参与者吞咽筛查失败，35 名参与者通过。在通过吞咽筛查的 35 名患者中，15 名患者在 VFSS 上被临床诊断为吞咽困难。尽管吞咽筛查的通过/失败并不是吞咽困难存在/不存在的显著预测因素，但包括喉抬高、喉前庭关闭和前舌骨运动在内的逻辑回归模型，以及性别，对吞咽筛查结果具有统计学意义。
该研究结果表明，对吸入风险的吞咽筛查可以识别最需要 VFSS 评估和吞咽困难管理的患者。此外，吞咽筛查失败的患者在 VFSS 上更有可能表现出与气道保护相关的生理损伤。
