Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Phipps 484, Baltimore, MD, 21287, USA.
Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Dysphagia. 2022 Dec;37(6):1715-1722. doi: 10.1007/s00455-022-10432-6. Epub 2022 Mar 10.
Dysphagia management is a core component of quality stroke care. Speech-Language Pathologists (SLPs) play a key role in the management of post-stroke dysphagia. We sought to elicit perceptions, attitudes, and practice patterns regarding post-stroke dysphagia management among SLPs in the United States. We conducted a survey among SLPs registered with the American Speech-Language-Hearing Association who indicated that they care for acute stroke patients. A total of 336 participants completed the survey. Over half of the participants (58.6%) indicated that they obtain objective swallow testing in ≥ 60% of their post-stroke dysphagia patients. Almost 1 in 5 SLPs indicated that they are often unable to perform objective dysphagia testing due to limited resources (18.8% indicated resource limitations; 78.9% indicated no resources limitations; 2.4% were unsure). SLPs in hospitals without stroke center certification had higher odds of indicating limited resources compared to SLPs in certified stroke centers (OR 2.08, 95% CI 1.11-3.87). Over 75% indicated that percutaneous endoscopic gastrostomy (PEG) tubes after stroke are placed too early. SLPs who obtain objective swallow testing in ≥ 60% of patients had higher odds of indicating that PEG tubes are placed too early (OR 1.70, 95% CI 1.13-2.56). While 19.4% indicated that the optimal timing for PEG after stroke is < 7 days after admission, 25.0% indicated that the optimal timing is > 12 days. Almost 35% indicated that health care system pressures influence their recommendations, and 47.6% indicated that ≥ 25% of PEGs could be avoided if patients were given up to 7 more days for swallowing recovery.
吞咽障碍管理是高质量卒中护理的核心组成部分。言语语言病理学家（SLP）在卒中后吞咽障碍管理中发挥着关键作用。我们旨在了解美国 SLP 对卒中后吞咽障碍管理的看法、态度和实践模式。我们对美国言语语言听力协会注册的、表示照顾急性卒中患者的 SLP 进行了一项调查。共有 336 名参与者完成了调查。超过一半的参与者（58.6%）表示，他们在≥60%的卒中后吞咽障碍患者中进行了客观吞咽测试。近五分之一的 SLP 表示，由于资源有限，他们经常无法进行客观的吞咽障碍测试（18.8%表示资源有限；78.9%表示无资源限制；2.4%不确定）。未获得卒中中心认证的医院的 SLP 比获得认证的卒中中心的 SLP 更有可能表示资源有限（OR 2.08，95%CI 1.11-3.87）。超过 75%的人表示卒中后经皮内镜下胃造口术（PEG）管放置过早。在≥60%的患者中进行客观吞咽测试的 SLP 更有可能表示 PEG 管放置过早（OR 1.70，95%CI 1.13-2.56）。虽然 19.4%的人表示卒中后 PEG 的最佳时机是入院后<7 天，但 25.0%的人表示最佳时机是>12 天。近 35%的人表示医疗保健系统的压力影响他们的建议，47.6%的人表示如果给患者多达 7 天的时间恢复吞咽功能，可避免≥25%的 PEG。
