Algorithm Helps Predict Recovery of Swallowing After Stroke, Need for Enteral Tube Feeding

By Reuters Staff

NEW YORK (Reuters Health) - Clinicians from the UK and Switzerland have developed and validated a simple scoring algorithm to help predict recovery from dysphagia after stroke and the need for enteral tube feeding.

"Predicting the duration of poststroke dysphagia is important to guide therapeutic decisions. Guidelines recommend nasogastric tube (NGT) feeding if swallowing impairment persists for 7 days or longer and percutaneous endoscopic gastrostomy (PEG) placement if dysphagia does not recover within 30 days, but, to our knowledge, a systematic prediction method does not exist," they note in a report online February 11 in JAMA Neurology.

The Predictive Swallowing Score was developed by Dr. Marian Galovic of the University College London Queen Square Institute of Neurology and colleagues, with 153 patients in the derivation cohort and 126 in the validation cohort. All patients had acute ischemic stroke and initially severe dysphagia, with Functional Oral Intake Scale (FOIS) scores of less than 5.

The main outcomes were recovery of oral intake (FOIS score of 5 or greater, primary end point) or return to prestroke diet (secondary end point) measured seven days after stroke (indication for NGT feeding) and 30 days after stroke (indication for PEG feeding).

Overall, 64% of participants failed to recover functional oral intake within seven days and 30% within 30 days. The final Predictive Swallowing Score included five variables: age, stroke severity on admission, lesion location, initial risk of aspiration and initial impairment of oral intake.

Prediction estimates ranged from 5% (with a score of 0) to 96% (with a score of 10) for a persistent impairment of oral intake on day seven and from 2% to 62% on day 30.

Model performance in the validation cohort showed a discrimination (C statistic) of 0.84 (95% confidence interval, 0.76 to 0.91; P<0.001) for predicting the recovery of oral intake on day seven and 0.77 (95% CI, 0.67 to 0.87; P<0.001) on day 30: for return to prestroke diet, the discrimination was 0.94 (95% CI, 0.87 to 1.00; P<0.001) on day seven and 0.71 (95% CI, 0.61 to 0.82; P<0.001) on day 30.

There was "high agreement" between the predicted and observed outcomes, the researchers report.

The Predictive Swallowing Score is available as a free smartphone and tablet app called "PRESS calc" on Apple iOS and Google Android.

The PRESS calc tool has "immediate practical implications" for clinicians as it can be easily estimated at the bedside to guide decisions about enteral tube feeding in people with dysphagia after ischemic stroke, the researchers write.

They stress that almost two-thirds of patients with an initially severe dysphagic stroke did not recover functional oral intake within seven days and therefore would benefit from NGT feeding. Nearly one-third did not recover within 30 days and would qualify for PEG feeding.

In addition, almost no individuals with severe post-stroke dysphagia returned to their prestroke diet within a week and two-thirds continued to require diet modification one month after stroke.

"This will be helpful in advising people with stroke and their relatives and might offer realistic expectations for the provision of health care services," the researchers conclude.

The study had no commercial funding.

SOURCE: https://bit.ly/2RXaP4X

JAMA Neurol 2019.

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