Kaiser Permanente Northern California, Redwood City Medical Center, Redwood City, CA.
Kaiser Permanente Northern California Regional Licensing, Quality and Accreditation, Oakland, CA.
Perm J. 2020 Dec;24:1. doi: 10.7812/TPP/19.230.
Dysphagia occurs in up to 50% of patients with acute stroke symptoms, resulting in increased aspiration pneumonia rates and mortality. The purpose of this study was to validate a health system's dysphagia (swallow) screening tool used since 2007 on all patients with suspected stroke symptoms. Annual rates of aspiration pneumonia for ischemic stroke patients have ranged from 2% to 3% since 2007.
From August 17, 2015 through September 30, 2015, a bedside dysphagia screening was prospectively performed by 2 nurses who were blinded to all patients age 18 years or older admitted through the emergency department with suspected stroke symptoms at 21 Joint Commission accredited primary stroke centers in an integrated health system. The tool consists of 3 parts: pertinent history, focused physical examination, and progressive testing from ice chips to 90 mL of water. A speech language pathologist blinded to the nurse's screening results performed a formal swallow evaluation on the same patient.
The end study population was 379 patients. Interrater reliability between 2 nurses of the dysphagia screening was excellent at 93.7% agreement (Ƙ = 0.83). When the dysphagia screenings were compared with the gold standard speech language pathologist professional swallow evaluation, the tool demonstrated both high sensitivity (86.4%; 95% confidence interval = 73.3-93.6) and high negative predictive value (93.8%; 95% confidence interval = 87.2-97.1).
This tool is highly reliable and valid. The dysphagia screening tool requires minimal training and is easily administered in a timely manner.
多达 50%的急性中风症状患者会出现吞咽困难，这导致吸入性肺炎的发生率和死亡率增加。本研究的目的是验证自 2007 年以来用于所有疑似中风症状患者的健康系统吞咽（吞咽）筛查工具。自 2007 年以来，缺血性中风患者的吸入性肺炎年发生率在 2%至 3%之间。
2015 年 8 月 17 日至 9 月 30 日，在一个综合医疗系统的 21 个联合委员会认证的初级中风中心，2 名护士对通过急诊部门入院的所有年龄在 18 岁或以上的疑似中风症状的患者进行了前瞻性床边吞咽困难筛查。该工具由 3 部分组成：相关病史、重点体格检查和从冰沙到 90 毫升水的渐进测试。一名语言病理学家对护士的筛查结果不知情，对同一名患者进行了正式的吞咽评估。
最终研究人群为 379 名患者。2 名护士的吞咽筛查之间的观察者间可靠性极好，一致性为 93.7%（Ƙ=0.83）。当吞咽筛查与语言病理学家专业吞咽评估的金标准进行比较时，该工具表现出高敏感性（86.4%；95%置信区间=73.3-93.6）和高阴性预测值（93.8%；95%置信区间=87.2-97.1）。
该工具具有高度的可靠性和有效性。吞咽筛查工具所需的培训最少，并且可以及时进行管理。
