Can bedside assessment reliably exclude aspiration following acute stroke?
Can bedside assessment reliably exclude aspiration following acute stroke?
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DOI：
10.1093/ageing/27.2.99
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发表时间：
1998-03-01
期刊：
影响因子：
6.7
通讯作者：
Martin, DF
中科院分区：
文献类型：
--
作者：
Smithard, DG;O'Neill, PA;Martin, DF
目的：研究床边吞咽评估可靠排除急性卒中后误吸的能力，研究对象：两所医院在卒中发作后24小时内收治的连续患者。在可能的情况下，所有患者在入院当天由医生和语言治疗师使用标准化的形式评估他们的吞咽能力，并在入院后3天内进行电视透视检查。20例（21%）患者出现吸气，尽管10例患者在床边未检测到吸气。18例（22%）患者的言语和语言治疗师认为吞咽不安全。39例患者（41%）出现不安全吞咽。由言语和语言治疗师进行的床边评估得出，存在误吸的敏感性为47%，特异性为86%，阳性预测值（PPV）为50%，阴性预测值（NPV）为85%。多元逻辑回归被用来确定床旁评估的最佳因素，以预测吸入的存在。一个微弱的自愿咳嗽和任何意识水平的改变，灵敏度为75%，特异性为72%，PPV为41%，NPV为91%的aspiration.Conclusion：床边评估吞咽缺乏必要的敏感性，作为筛选工具，在急性中风，但有使用视频透视作为金标准的关注。抽吸和床旁评估在预测并发症和结果方面的相对重要性需要研究。
Objective: to investigate the ability of a bedside swallowing assessment to reliably exclude aspiration following acute stroke.Subjects: consecutive patients admitted within 24 h of stroke onset to two hospitals.Methods: a prospective study. Where possible, all patients had their ability to swallow assessed on the day of admission by both a doctor and a speech and language therapist using a standardized proforma, A videofluoroscopy examination was conducted within 3 days of admission.Results: 94 patients underwent videofluoroscopy; 20 (21%) were seen to be aspirating, although this was not detected at the bedside in 10, In 18 (22%) of the patients the speech and language therapist considered the swallow to be unsafe, In the medical assessment, 39 patients (41%) had an unsafe swallow. Bedside assessment by a speech and language therapist gave a sensitivity of 47%, a specificity of 86%, positive predictive value (PPV) of 50% and a negative predictive value (NPV) of 85% for the presence of aspiration. Multiple logistic regression was used to identify the optimum elements of the bedside assessments for predicting the presence of aspiration. A weak voluntary cough and any alteration in conscious level gave a sensitivity of 75%, specificity of 72%, PPV of 41% and NPV of 91% for aspiration.Conclusion: bedside assessment of swallowing lacks the necessary sensitivity to be used as a screening instrument in acute stroke, but there are concerns about the use of videofluoroscopy as a gold standard. The relative importance of aspiration and bedside assessment in predicting complications and outcome needs to be studied.