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Minerva Medica 2020 Apr 23

DOI: 10.23736/S0026-4806.20.06571-4

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

May ultrasonography be considered a useful tool for bedside screening of dysphagia in patients with acute stroke? A cohort study

Alessandro PICELLI 1, 2 , Angela MODENESE 2, Elena POLETTO 1, Valentina BUSINARO 1, Valentina VARALTA 1, Marialuisa GANDOLFI 1, 2, Bruno BONETTI 3, Nicola SMANIA 1, 2

1 Neuromotor and Cognitive Rehabilitation Research Center, Physical and Rehabilitation Medicine Section, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy; 2 Neurorehabilitation Unit, Department of Neurosciences, University Hospital of Verona, Verona, Italy; 3 Stroke Unit, Department of Neurosciences, University Hospital of Verona, Verona, Italy


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BACKGROUND: Dysphagia is a primary risk factor for pneumonia and affects around 50% of acute stroke patients. Systematic bedside swallowing screening of acute stroke patients is recommended before oral intake. Currently there is lack of comprehensive dysphagia assessment tools with robust good accuracy, clinical utility and cost-effectiveness. An altered hyoid bone movement may represent a major risk factor for aspiration . Ultrasonography quantitatively measures hyoid-larynx approximation, which was found reduced in stroke patients with dysphagia. Although ultrasonography was suggested for assessing stroke patients with dysphagia, there is lack of evidence about the acute phase of stroke. Thus, our aim was to investigate the use of ultrasonography for bedside screening of dysphagia in acute stroke patients.
METHODS: Nineteen acute stroke patients were included. Each patient performed clinical bedside screening for dysphagia by means of the Gugging Swallow Screen and the Functional Oral Intake Scale. Furthermore, all patients underwent ultrasonography in order to measure the distance between the thyroid cartilage and hyoid bone during swallowing (water bolus of 3 mL). The hyoid-larynx approximation distance [obtained by subtracting (a - b) the shortest distance between the hyoid bone and thyroid cartilage during swallowing (b) from the initial resting distance (a) and degree {[(a - b) / a] x 100} were calculated.
RESULTS: The Functional Oral Intake Scale showed a significant direct association with the hyoid-larynx approximation distance (P=0.011) and degree (P=0.005). Also, the Gugging Swallow Screen showed a significant direct association with the hyoid-larynx approximation distance (P=0.008) and degree (P=0.004). The hyoid-larynx approximation distance and degree were significantly reduced in dysphagic patients.
CONCLUSIONS: Our findings support the use of ultrasonography in aid of swallowing clinical (non-instrumental) evaluation for the bedside screening of dysphagia in acute stroke patients.


KEY WORDS: Deglutition disorders; Diagnostic imaging; Rehabilitation

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