Speech-Language Pathologist-led Fiberoptic Endoscopic Evaluation of Swallowing: Functional Outcomes for Patients after Stroke
Speech-Language Pathologist-led Fiberoptic Endoscopic Evaluation of Swallowing: Functional Outcomes for Patients after Stroke
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DOI：
10.1016/j.jstrokecerebrovasdis.2013.09.031
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发表时间：
2014-03-01
影响因子：
2.5
通讯作者：
Miles, Anna
中科院分区：
文献类型：
--
作者：
Bax, Louise;McFarlane, Mary;Miles, Anna
背景：吞咽困难是卒中后常见的并发症，与肺炎的发生有关。因此，早期发现吞咽困难，特别是误吸，对预防肺炎至关重要。纤维内镜吞咽评估（FEES）是一种安全的床边工具，用于检测吞咽困难和误吸，因此，有可能为吞咽困难的治疗提供信息。本研究调查了言语语言病理学家主导的FEES服务对急性卒中后患者功能结局的临床效用。研究方法：回顾性文件审计进行了220例患者FEES之前，介绍了220例患者实施后，语音语言病理学家领导的FEES服务。主要结局指标为肺炎发生率，次要结局指标包括死亡率、出院时饮食、出院目的地、无口喂养持续时间、非口服喂养发生率和住院时间。结果：有一个显着的增加，在该组的工具评估使用FEES（P <0.001）。有一个显着的减少肺炎率在组中获得FEES（P = 0.037）。患者出院时接受标准饮食的可能性也明显更大（P = 0.004），但非口服喂养的时间更长（P = 0.013），住院时间更长（P <0.001）。结论：当选择性地使用时，FEES服务有可能改善卒中后患者的功能结局。
Background: Dysphagia is a common complication after stroke and is associated with the development of pneumonia. Early detection of dysphagia and specifically aspiration is, therefore, critical in the prevention of pneumonia. Fiberoptic endoscopic evaluation of swallowing (FEES) is a safe bedside instrumental tool for detecting dysphagia and aspiration and, therefore, has the potential to inform dysphagia management. This study investigated the clinical utility of a speech-language pathologist-led FEES service on functional outcomes for patients after acute stroke. Methods: A retrospective file audit was carried out on 220 patients before FEES was introduced and on 220 patients after the implementation of a speech-language pathologist-led FEES service. The primary outcome measure was incidence of pneumonia, and secondary outcome measures included mortality, diet on discharge, discharge destination, duration nil-by-mouth, incidence of nonoral feeding, and length of stay. Results: There was a significant increase in instrumental assessment use in the group that had access to FEES (P < .001). There was a significant reduction of pneumonia rates in the group that had access to FEES (P = .037). Patients were also significantly more likely to leave hospital on standard diets (P = .004) but had longer periods of nonoral feeding (P = .013) and increased length of hospitalization (P < .001). Conclusion: When used selectively, FEES services have potential for improving functional outcomes for patients after stroke.