National Institutes of Health Stroke Scale (NIHSS) as An Early Predictor of Poststroke Dysphagia

Abstract Background Despite the availability of multiple comprehensive screening methods to detect dysphagia during acute stroke care, consensus is lacking as to the best practice. Our previous study demonstrated favorable sensitivity of the Functional Independence Measure (FIM) compared with a beds...

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Bibliographic Details
Published in:PM & R 2015-06, Vol.7 (6), p.593-598
Main Authors: Jeyaseelan, Rebecca D., MBBS, MD, Vargo, Mary M., MD, Chae, John, MD
Format: Article
Language:English
Subjects:
Aged
Deglutition Disorders - diagnosis
Deglutition Disorders - etiology
Deglutition Disorders - rehabilitation
Female
Follow-Up Studies
Humans
Male
Middle Aged
National Institutes of Health (U.S.)
Physical Medicine and Rehabilitation
Predictive Value of Tests
ROC Curve
Severity of Illness Index
Stroke - complications
Stroke - diagnosis
Stroke Rehabilitation
Time Factors
United States
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Summary:Abstract Background Despite the availability of multiple comprehensive screening methods to detect dysphagia during acute stroke care, consensus is lacking as to the best practice. Our previous study demonstrated favorable sensitivity of the Functional Independence Measure (FIM) compared with a bedside 3-sip test. However, the FIM is challenging to administer during acute stroke care. The National Institutes of Health Stroke Scale (NIHSS) is administered routinely in the emergency department. Objective To evaluate the utility of the NIHSS as a predictor of clinically relevant poststroke dysphagia compared with FIM data in the same cohort. Design Retrospective analysis. Setting Academic medical center. Patients Individuals with acute stroke who were admitted for acute care and later transferred to acute rehabilitation within the same institution. Methods Clinically relevant dysphagia was defined as aspiration on modified barium swallow or laryngeal penetration on modified barium swallow requiring diet change, or aspiration pneumonia. NIHSS and FIM scores were compiled for all patients. Main Outcome Measurements Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for NIHSS and FIM. Sensitivity and specificity of different values of NIHSS and FIM were analyzed via receiver operator characteristic curves. Results Of 290 patients admitted to acute stroke rehabilitation, 88 (30%) manifested clinically relevant dysphagia during their rehabilitation stay. Sensitivity analyses suggested cut-off values for the NIHSS and the FIM of >9 and 9 and FIM
ISSN:1934-1482
1934-1563
DOI:10.1016/j.pmrj.2014.12.007