Abstract 28: A Nursing Swallow Screen is Better Than the National Institutes of Health Stroke Scale at Predicting Dysphagia

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Introduction: The Joint Commission recommends all acute stroke patients undergo swallow screening prior to any oral intake to decrease risk of aspiration pneumonia. In a 2009 study, a nursing swallow screening tool was compared to the National Institutes of Health Stroke Scale (NIHSS) to identify dysphagia in acute stroke patients. They found the NIHSS was a better predictor for identifying dysphagia. This IRB-approved study replicated and expanded the 2009 study in a community hospital with stroke patients using a facility-based nursing Stroke Swallow Screen (SSS).

Hypothesis: The investigators hypothesized that the results would corroborate the 2009 study for the purpose of streamlining acute stroke assessment in the Emergency Department (ED).

Methods: SSS results, NIHSS scores and speech-language pathology (SLP) swallowing evaluations of adult ischemic and hemorrhagic stroke patients were collected retrospectively via medical chart review. SSS results and NIHSS scores were compared against the “gold standard” for dysphagia diagnosis, the SLP evaluation. Convenience sampling, based on diagnosis within a 24-month time interval, determined the study sample.

Results: Dysphagia prevalence among subjects (N=240) was 45%. The SSS demonstrated 95.4% sensitivity compared to 80.6% for the NIHSS.

Conclusion: The SSS was a better predictor for presence of dysphagia in acute stroke patients than the NIHSS. Our findings stand in contrast to the 2009 report, in which dysphagia sensitivities of their screening tool and the NIHSS were 29% and 79%, respectively. Therefore, streamlining these ED stroke assessments would not be efficacious in our facility.

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