Development of dysphagia protocol in Ankara City Hospital stroke patients

Introduction and Aim: Dysphagia is a common symptom in patients with acute stroke. It is associated with malnutrition, aspiration pneumonia and mortality. Therefore, early detection and treatment of dysphagia is important. In this study, it was aimed to provide a standardization in clinical practice and follow-up with objective data by creating a dysphagia screening and rehabilitation protocol in stroke patients. In addition, it was aimed to determine the factors affecting the severity and prognosis of dysphagia in patients with dysphagia. Materials and Method: In this study, a total of 55 patients, 26 females and 29 males, aged 18-85 years, who were admitted to Ankara City Hospital Neurology Clinics and diagnosed with acute stroke by a neurologist, and who were diagnosed with dysphagia were included. Demographic characteristics and clinical histories of the patients were recorded, and neurological examinations were performed. The clinical parameters of the patients were evaluated with the Mini Mental Test (MMT), National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI), Functional Ambulation Categories (FAC) and Rankin scale, and the outcomes of the patients who underwent videofluoroscopy (VFS) as advanced examination were evaluated with the Penetration-Aspiration Scale (PAS) prior to therapy. Patients' swallowing assessments were performed before therapy, at discharge and 1 after therapy with the Gugging Swallowing Screen (GUSS) and Eating Assessment Tool-10 (EAT-10). The patients were included in the early rehabilitation program and were followed up for mortality and morbidity during the hospitalization period and for 1 month after discharge. Results: Significant relationships were found between before therapy dysphagia score and incontinence, oxygen support, tongue, lip, and palatal movements, gag reflex, and aphasia (p <0,05). There was a negative correlation between before therapy dysphagia score and NIHSS score, and a positive correlation between Body Mass Index (BMI), Barthel Index and FAS score (p <0,05). Significant relationships were found between the difference in after therapy dysphagia change score and oral hygiene, stroke history and stroke type (p <0,05). A negative correlation was found between before therapy GUSS score and EAT-10 score (p <0,05). The after therapy, a significant improvement was found in GUSS and EAT-10 scores (p <0,05). Conclusions: In our study, we found that the early dysphagia screening and rehabilitation protocol applied to the patients was effective in improving dysphagia and decreasing the mortality and morbidity rate that may develop. In addition, we found that factors such as BMI, incontinence, oxygen need, tongue, lip, and palatal movements, gag reflex, aphasia, NIHSS, Barthel and FAS score affect the severity of dysphagia; oral hygiene, previous stroke history and stroke type affect dysphagia prognosis. We think that the use of our Dysphagia Protocol of Stroke Patients in Ankara City Hospital will help an optimum clinical evaluation, correct and effective use of imaging methods, and follow-up patients with appropriate dietary modification and rehabilitation program to reduce mortality and morbidity. Keywords: Dysphagia, acute stroke, early dysphagia rehabilitation, clinical protocol