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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Aspiration is an important variable related to increased morbidity, mortality, and cost of care for acute stroke patients. This prospective systematic replication study compared a clinical swallowing examination consisting of six clinical identifiers of aspiration risk, i.e., dysphonia, dysarthria, abnormal gag reflex, abnormal volitional cough, cough after swallow, and voice change after swallow, with an instrumental fiberoptic endoscopic evaluation of swallowing (FEES) to determine reliability in identifying aspiration risk following acute stroke. A referred consecutive sample of 49 first-time stroke patients was evaluated within 24 hours poststroke, first with the clinical examination followed immediately by FEES. The endoscopist was blinded to results of clinical testing. The clinical examination correctly identified 19 subjects with aspiration risk, when compared with the criterion standard FEES, but incorrectly identified 3 patients as having no aspiration risk when they did. The clinical examination incorrectly identified 19 subjects with aspiration risk but determined correctly no aspiration risk in 8 patients who did not exhibit aspiration risk on FEES. Clinical examination sensitivity = 86%; specificity = 30%; false negative rate = 14%; false positive rate = 70%; positive predictive value = 50%; and negative predictive value = 73%. It was concluded that the clinical examination, when compared with FEES, underestimated aspiration risk in patients with aspiration risk and overestimated aspiration risk in patients who did not exhibit aspiration risk. Careful consideration of the limitations of clinical testing leads us to believe that a reliable, timely, and cost-effective instrumental swallow evaluation should be available for the majority of patients following acute stroke.
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PMID:Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. 1458 80

In an attempt to minimize late airway stenosis, a new tube with an oval cross-section has been developed. Two to three tracheal cartilage arches are usually incised anteriorly, partially excised or inadvertently broken to fit a tracheostomy tube. The risk of post-tracheostomy stenosis seems to be greater when several cartilages have been involved. If an oval tube with the shortest diameter in its symmetry plane is used, the tissue defect along the longitudinal axis of the trachea will be shorter than that caused by a round tube. When such a stoma is healing, the adjacent intact tracheal cartilages, which are located fairly close to each other, will support the bridging scar tissue, thereby preventing collapse of the tracheal wall. The tubes come in three lengths to fit most neck sizes. An oval trial tube with the same length as the shortest one has been used for cricothyroidostomy--the aim being to spread the cricoid and thyroid cartilages apart as little as possible. A series of 23 patients were treated with this tube. At follow-up, no stenosis was found at flexible fiberoptic laryngo-tracheoscopy. Fifteen patients reported no voice change, and five, who were singers, experienced lower pitch, but four of them were still singing. None of these five patients had speech problems. The other three patients had voice problems when speaking. One of these had chronic bronchitis and another had had a stroke. The third one had a rough voice. The voice problems were milder than those reported from previous series.
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PMID:New design of a tracheostomy-cricothyroidostomy tube. 1270 11

This retrospective study determined whether specific neurological features were associated with initial and final swallowing outcomes in acute stroke patients. A chart review of 65 acute stroke patients suggested that certain clinical and neurocognitive behaviors were associated with swallowing outcomes. Hemispatial neglect was significantly associated with initial nonoral dietary intake, whereas aphasia was not associated with swallowing outcome. Results from the initial clinical swallowing evaluations suggested that the presence of at least four of six clinical features (cough after swallow, voice change after swallow, abnormal volitional cough, abnormal gag reflex, dysphonia, and dysarthria) were associated with poor initial and final swallowing outcomes. Whether specific lesion location, size, or a combination of clinical neurological deficits are associated with poor initial and final swallowing outcomes is unclear. Prospective studies are warranted for further investigation of these relationships.
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PMID:Clinical and cognitive predictors of swallowing recovery in stroke. 1704 16