Heckert KD, Komaroff E, Adler U, Barrett AM.
Stroke. 2009 Apr;40(4):1381-5. Epub 2009 Feb 19.
BACKGROUND AND PURPOSE:
Accurate identification and tailored management of patients with dysphagia is necessary to prevent complications when dysphagia is present and avoid implications of dietary restriction when unnecessary. Methods of dysphagia assessment vary, and a reassessment in the postacute period is not an established standard. The aim of this retrospective study was to compare initial dysphagia assessment with dysphagia reassessment results for stroke patients admitted to our inpatient rehabilitation facility.
We examined medical records of 226 acute stroke patients admitted to our inpatient rehabilitation facility from December 2006 to May 2007. We excluded 86 subjects, then noted the presence or absence of dysphagia based on documentation and prescribed diet and management strategies in the remaining 146 records.
Dysphagia was identified in 94 patients (64%) assessed at our facility. Of these patients, 11% (n=10) were not previously identified in acute care (nonnegligible number, P<0.0001). Agreement regarding presence or absence of dysphagia occurred in 85%. However, prescribed diet differed in 51% (n=75), with 12% (n=18) requiring diet downgrades on admission for rehabilitation.
The necessity of dysphagia reassessment as part of routine postacute stroke rehabilitation care is not completely established. Our study supports the need for postacute reassessment as 11% of patients with dysphagia would not have been identified without reassessment and 12% required diets more conservative than prescribed in acute care. Prospective research addressing dysphagia specific outcomes is warranted to develop efficient and high-quality standards for preventing poststroke dysphagia associated morbidity.