Clinical Study On Bedside Assessment Of Dysphagia In Patients With Acute Cerebral Infarction

PARTâ… Clinical Study on Bedside Assessment of Dysphagia in Patients with Acute Cerebral InfarctionObjective To analyze the precictors factors from the two bedside assessments of dysphagia in acute cerebral infarction(ACI): Standardized Swallowing Assessment(SSA) and Scottish Intercollegiate Guidelines(SIG) which are widely used in the world currently. Compare the results of the assessments above and the golden standard Videofluoroscopic Swallowing Study(VFSS). Then found a modified bedside swallowing assessment. Methods 117 ACI patients were enrolled in the study. Within 24 hours of their hospitalization, bedside swallowing function envaluation was carried out with Standard Swallowing Assessment (SSA) and Scottish Intercollegiate Guidelines (SIG) and some other bedside index: dysarthria, motor speech function, gag reflex, abnormal voluntary cough, cough, voice changesalivation, choking, laryngeal elevation, nasal reflux, throat clearance, accelerated breathing, facial muscle paralysis, breathlessness, repeated swallowing. Within 72 hours , the gold standard of dysphagia diagnosis Video Fluroscoipc Swallowing Study(VFSS) was carried out by which dysphagia could be defined . Independent factors were extracted from the factors above by factor loading matrix, and the sensitivities and specificities could be counted out. With the analysis results compare the two bedside swallowing assessments and if possible get a better assessment to evaluate the swallowing function for our clinical work.Results 1.52 patients were defined to be dysphagia by VFSS. After Factor Analysis the indexes above were divided into 7 groups as follow, 1: breathlessness, repeated swallowing, aspiration and pharyngeal residue, showing the disability of the pharyngeal function with the variance of 14.235%.2: accelerated breathing, laryngeal elevation and salivation, showing the disability of the muscle function of pharyngeal constrictors, muscles around laryngeal, orbicularis oris muscle with the variance of 12.048%.3:cough,choking and throat clearance ,they come from the stimulation of food in pharyngeal or laryngeal ,the variance was 11.213%.4: voice change and nasal reflux, showing the disability of levator veli palatini,tensor veli palatini and musculus uvulae with the variance of 9.886%.5: disability of motor speech function, as well as motor aphasia, the result was that it act as the independent factor for dysphagia, the variance was 9.453%.6:gag reflex and delayed pharyngeal swallow, disability of gag reflex may make food stay in the oral cavity and in the imaging materials we could find the delayed pharyngeal swallow, so they are of the same factor with the variance of 8.458%.7: dysarthria and facial muscle paralysis, facial muscle paralysis may result to dysarthria, and both of them could destroy the tongue motor function to roll food to bolus and pass it on, sometimes even combined with ageusia, the variance was 8.437%. 2.Compare the three assessments SSA, SIG, SSA&SIG, The sensitivity, negative predict value and positive likelihood ratio of SSA&SIG were better(92.30%, 0.927 and 0.12). The specificity, positive predict value, positive likelihood ratio, correlations and Youden's index of SIG were better(93.84%, 0.918, 14.05, 0.905 and 0.804). 3. The results of McNemar tests were that the difference between SSA and VFSS or SIG and VFSS had not reached the statistical difference(P=0.238,0.549), the difference between SSA&SIG and VFSS had reached that(P=0.031). the difference between SIG and the other two assessments had reached the statistical difference(P=0.035,0.000).The result of SSA&SIG with SSA had not reached the statistical difference(P=0.125). The Kappa of SIG and VFSS was 0.809(P=0.055)better than the others.Conclusion 1. Both SSA and SIG are effective in dysphagia screening. The differences of them to golden standard had not reached the statistical difference. 2. The difference of SSA and SIG had reached the statistical difference, so the two assessments effect differently. 3. The specificity, positive predict value, positive likelihood ratio, correlations and Youden's index of SIG were better than the other two and SIG had a higher coherence with the golden standard, so SIG was better than the others. 4.SSA&SIG was not better that the original ones. 5.SIG did not comprise some important factors got from factor analysis, a new assessment was founded and added with gag reflex or delayed pharyngeal swallow, the breath mode before, in and after swallowing, nasal reflux, salivation, as the Table 1.8 followed.PARTâ…¡Clinical study of the modified bedside swallowing assessmentObjective To screen the swallowing function of acute cerebral infarction(ACI)patients divided into four group by the Oxfordshire Community Stroke Project(OCSP) . Compare the results with Scottish Intercollegiate Guidelines(SIG) and Videofluoroscopic Swallowing Study(VFSS) to test the sensitivity and the specificity of it. Methods 117 ACI patients were enrolled in the study. Within 24 hours of their hospitalization, the assessments of MBSA and SIG and the classify of OCSP were carried out. Within 72 hours, the gold standard of dysphagia diagnosis VFSS was carried out by which dysphagia could be defined . Count the difference and the coherence with VFSS and the sensitivity, specificity of MBSA in different classifies of OCSP and compare them with the results of SIG.Results Statistic results of the difference of MBSA and VFSS had not reached the statistical difference(P=0.754). the Kappa was 0.828, got good coherence. In Total Anterior Circulation Infarction (TACI) patients, the sensitivities, specificities, correlations, the Youden's indexes were 1.00; in Partial Anterior Circulation Infarction (PACI) patients, the sensitivity of MBSA was higher than SIG, the specificity lower than SIG, the correlations and the Youden's indexes were the same; in Posterior Circulation Infarction (POCI) patients, the sensitivities, specificities, correlations, Youden's indexes were the same; in Lacunar Infarction (LACI) patients the sensitivity, correlation and the Youden's index were higher than SIG, the specificities equals. Compare the results above with t-text they had not reached the statistical difference(P=1.00, 1.00, 1.00, 0.11).Conclusion MBSA had coherence with the golden standard and had good sensitivity and specificity. MBSA could screen the swallowing function in Patients with acute cerebral infarction. Compared with SIG, MBSA had better sensitivity and specificity, but it had not reached the statistical difference.