Article
Prospective study to evaluate the neurodysphagia diagnostics using the NOD step concept during the acute treatment and neurorehabilitation of stroke patients
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Authors
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Rainer Müller
- Univ.-HNO-Klinik, Dresden, Germany
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Stefan Kuch
- Krankenhaus Freiberg, Freiberg, Germany
| Published: | July 24, 2014 |
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Outline
Text
Introduction: The intention of the present study is to evaluate the use of the NOD concept in clinical practice in a mostly unselected, large patient population with regard to practicability, time consumption, findings and assessments of swallowing diagnostics including the longterm follow-up.
Materials and methods: The studied population includes 676 patients with an average age of 68.5 years treated at the stroke unit or the intensive care unit of the Neurological Clinic within 12 month. The recording of swallowing function of 322 patients after 3 months is performed using a patient questionnaire and specialized diagnostics including clinical swallowing examination and transnasal endoscopy for patients whose answers in the questionnaire disallow a reliable measure of dysphagia level.
Results: 61.1% of 676 acutely hospitalized stroke patients had a normal swallowing, 11.5% mild dysphagia and 9.8% severe dysphagia. The Neurodysphagia screening was characterized by a highly positive predictive value for the detection of swallowing disorders. A highly significant accumulation of pneumonia of dysphagic patients during acute treatment was detected compared to patients without dysphagia. After 3 months 87.8% of 383 classified patients had a normal swallowing, 7.8% mild dysphagia and 4.4% severe dysphagia. An association between stroke evaluation scores during acute treatment and the severity of dysphagia after 3 months was found. Likewise pneumonia during acute hospitalization was significantly associated with existence of severe dysphagia after 3 months.
Conclusions: The NOD concept proved to be well practicable programme in clinical use that allows an early and reliable assessment of swallowing function for stroke patients requiring acceptable staff and time. Considering the incidence rates of pneumonia of 36.4% for patients with severe and 15.4% for patients with mild dysphagia, despite implementation of the NOD concept with derived consequences for nutrition and swallowing therapy, the effect of more generous and early usage of transnasal endoscopy should be tested to detect silent aspiration in patients with pathological Neurodysphagia screening. In the present study a proposal to streamline and simplify the documentation is presented.
