2017 Volume 39 Issue 1 Pages 12-18
Background and Purpose: Dysphagia after acute ischemic stroke is frequently associated with aspiration and pneumonia. Thickened liquids have been shown to prevent aspiration in acute ischemic stroke patients with a pseudobulbar palsy. We developed a simple bedside screening test to assess aspiration for thin liquids. The test is a combination of a modified 3-ml water drinking test (MWST) and a 2-ml 1% thickened liquid swallow test (TLST). In this study, we investigated the validity of this screening tool to identify high risk cases in acute ischemic stroke patients. Methods: Subjects included 450 consecutive acute ischemic stroke patients admitted to our hospital, excluding those with somnolence or coma, medullary infarction, and fatality. Screening began with the MWST. When positive for cough (n=104), patients were then given TLST. If cough was noted with TLST (n=22), patients were then considered high risk for developing aspiration pneumonia, and received intensive management. Rehabilitation programs were made according to the risk. We evaluated prognosis of the oral intake by the combined screening test and the rate of pneumonia at discharge. Logistic regression analyses were performed. Results: A total of 424 patients could successfully achieve an oral intake without aspiration pneumonia. The 2-step test, pneumonia, and bilateral lesion were related to the prognosis of the oral intake (p<0.01). The pneumonia rate was 1.1%. Conclusion: The 2-step test of MWST and TLST during the acute stage of ischemic stroke is valid to predict the prognosis of the oral intake.
