# Key indicators for prioritizing swallowing assessment in acute ischemic stroke patients in the emergency room

## TL;DR

This study identifies key indicators like age and stroke severity that help prioritize swallowing assessments in stroke patients to prevent complications like aspiration pneumonia.

## Contribution

The study introduces specific clinical indicators to prioritize dysphagia screening in acute ischemic stroke patients in emergency settings.

## Key findings

- Older age (≥69 years) and higher NIHSS scores (≥9) are strong indicators of dysphagia risk.
- Coughing during a 50-ml water swallow test is a reliable predictor of aspiration risk.
- Patients with higher stroke severity are more likely to require alternative feeding methods.

## Abstract

Stroke is a major cause of mortality and disability globally. Dysphagia is a frequent complication that increases the risk of aspiration pneumonia, a key contributor to stroke-related deaths. Early screening is essential for improving outcomes.

To identify clinical indicators that can help prioritize swallowing assessments in the emergency room, enabling faster and safer resumption of oral feeding.

A prospective cohort of 134 postacute ischemic stroke patients admitted to the emergency room was assessed. Patients were divided into 2 groups: G1 (at risk of dysphagia) and G2 (no risk). Swallowing function was evaluated using the Dysphagia Risk Evaluation Protocol (DREP) and the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale. A subset (n = 15) underwent videofluoroscopic swallowing study (VFSS). Stroke severity was measured using the National Institutes of Health (NIH) stroke scale (NIHSS). Statistical analyses included t-tests, Chi-squared test, Pearson's correlation, and Cochran's Q test (
p
 < 0.05).

Patients from G1 were older (mean: 69.1 vs. 63.0 years,
p
 = 0.023), had more severe strokes (NIHSS ≥ 9.8,
p
 = 0.002), and were more likely to require alternative feeding methods. Older age and longer hospital stays correlated with increased dysphagia risk. Coughing during the 50-ml water swallow test was a strong predictor of aspiration.

Key indicators of aspiration risk in postacute ischemic stroke patients include age ≥ 69, NIHSS score ≥ 9, and the need for alternative feeding. Coughing during the water swallow test is a valuable clinical predictor. Early identification can support targeted interventions and reduce complications.