Journal of Rehabilitation Research & Development (JRRD)

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Volume 46 Number 9, 2009
   Pages 1127 — 1134

Abstract — Comparison of two approaches to screen for dysphagia among acute ischemic stroke patients: Nursing admission screening tool versus National Institutes of Health Stroke Scale

Dawn M. Bravata, MD;1-5* Virginia S. Daggett, MSN, RN;1,4 Heather Woodward-Hagg, MS;1 Teresa Damush, PhD;1-2,4,6 Laurie Plue, MA;1,4 Scott Russell, BS;1 George Allen;1 Linda S. Williams, MD;1,3-5 Jaroslaw Harezlak, PhD;7 Neale R. Chumbler, PhD1,4-5,8

1Center of Excellence on Implementing Evidence-Based Practice, Department of Veterans Affairs (VA) Health Services Research & Development (HSR&D), Richard L. Roudebush VA Medical Center, Indianapolis, IN; Departments of 2Internal Medicine and 3Neurology, Indiana University School of Medicine, Indianapolis, IN; 4Stroke Quality, VA HSR&D Enhancement Research Initiative Program, Washington, DC; 5Regenstrief Institute, Indianapolis, IN; 6Indiana University Center for Aging Research, Indianapolis, IN; 7Division of Biostatistics, Indiana University School of Medicine, Indianapolis, IN; 8Department of Sociology, Indiana University School of Liberal Arts, Indiana University Purdue
University Indianapolis, Indianapolis, IN

Abstract — This study assessed the positive and negative predictive values and the sensitivity and specificity of a nursing dysphagia screening tool and the National Institutes of Health Stroke Scale (NIHSS) for the identification of dysphagia for veterans hospitalized with ischemic stroke. A secondary objective of this study was to evaluate the speech-language pathology consult rate before and after the nursing admission dysphagia screening tool. This retrospective cohort study evaluated veterans admitted to one Department of Veterans Affairs medical center with ischemic stroke during the 6 months both before and after the implementation of a nursing dysphagia screening tool, which was part of the admission nursing template. Stroke severity was measured with the use of the retrospective NIHSS. Dysphagia diagnosis was based on speech-language pathology evaluations. Dysphagia was present in 38 of 101 patients (38%) with ischemic stroke. The nursing dysphagia screening tool had a positive predictive value of 50% and a negative predictive value of 68%, with a sensitivity of 29% and specificity of 84%. The use of the NIHSS to identify dysphagia risk had a positive predictive value of 60% and a negative predictive value of 84%. The NIHSS had better test characteristics in predicting dysphagia than the nursing dysphagia screening tool. Future research should evaluate the use of the NIHSS as a screening tool for dysphagia.

Key words: aspiration risk, dysphagia screening, ischemic stroke, NIH Stroke Scale, nursing admission, pneumonia prevention, predictive value of tests, sensitivity and specificity, stroke swallowing assessment.


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