Galovic, M. et al. (2019). Development and validation of a prognostic model of swallowing recovery and enteral feeding after ischemic stroke. JAMA Neurology, 76(5), 561-570. doi:10.1001/jamaneurol.2018.4858
*In a study completed by University College London, researchers sought to develop a tool that could be used to predict recovery of swallowing abilities following an ischemic stroke and help guide decision making regarding placement of an NGT and/or PEG.
*A large sample size was used (N=279 ) which included participants from the derivation cohort (to create the predictive tool) and those in the validation cohort (to determine the validity of the tool). Those individuals included in the study experienced an ischemic stroke, were admitted to the hospital <48 hours following sx onset, and a functional oral intake score (FOIS) <5.
*Swallowing evaluations were completed: 1-2 days after stroke, >1 week post-stroke, @ discharge, and then >30 post-stroke.
*Per recommendations of the American Gastroenterological Association and British Society of Enterology, NGT placement is recc’d if oral intake does not recover w/in 7 days; PEG placement if oral intake has not recovered w/in 30 days.
*Results indicated that after 7 days, 64% of participants had oral intake impairments which could warrant NGT placement. After 30 days, 30% of participants qualified for PEG placement. Furthermore, 94% of participants weren’t able to eat their pre-stroke diet 7 days post-stroke and 66% were unable to eat their pre-stroke diet 30 days post-stroke.
*Based upon swallowing recovery of those in the cohort, 5 factors were found to be correlated with recovery time: initial FOIS score, if infarct occurred to the frontal operculum, initial aspiration risk, age, and NIHSS (stroke scale per neurologist).
*How to use the tool: if a patient were to receive a 5 on the PRESS, there would be a ~55% chance the pt would present with impaired oral intake 7 days post-stroke but only a 16% chance 30 days post-stroke.
*It should go without saying that this type of tool does not replace instrumental swallowing assessments; however, this type of model is useful for clinicians when making recommendations to members of the healthcare team as well as their patients.
Speech Path Facts 