Acute Crit Care.  2022 Aug;37(3):276-285. 10.4266/acc.2021.01375.

Early assessment of aspiration risk in acute stroke by fiberoptic endoscopy in critically ill patients

• Elsyaad MSA
• Fayed AM
• Megahed MMAS
• Hamouda NH
• Elmenshawy AM

• KMID: 2535290
• DOI: http://doi.org/10.4266/acc.2021.01375

Abstract

Background
Fiberoptic endoscopic evaluation of swallowing (FEES) has been recommended to assess aspiration in stroke. This study aimed to determine the diagnostic and prognostic roles of FEES in the early assessment of aspiration, intensive care unit (ICU) stay and mortality in acute stroke patients.
Methods
Fifty-two patients with acute stroke admitted to the Alexandria Main University Hospital were included. Complete examinations and assessment of aspiration using the 8-point penetration-aspiration scale (PAS) with FEES protocol were performed.
Results
The patients were classified into three groups: normal with no or low risk of aspiration (n=15, 27.3%; PAS level 1), low to moderate risk (n=8, 14.5%; PAS level 2–4), and high risk (n=32, 58.2%; PAS ≥5). There was high incidence of aspiration pneumonia, prolonged ICU stay, and mortality in both moderate- and high-risk groups (P=0.001, P<0.001, and P<0.001, respectively). The PAS score predicted aspiration pneumonia (hospital-acquired pneumonia) with sensitivity and specificity of 80.0% and 76.0%, respectively (negative predictive value [NPV], 76.0; positive predictive value [PPV], 80.0; 95% confidence interval [CI], 0.706–0.940) and mortality with sensitivity and specificity of 88.46% and 68.97% (NPV, 87.0; PPV, 71.9; 95% CI, 0.749–0.951). The PAS score could predict the length of ICU stay with sensitivity and specificity of 70.21% and 87.50, respectively (NPV, 33.3; PPV, 97.1; 95% CI, 0.605–0.906).
Conclusions
The standard FEES protocol using PAS score is a useful tool to assess aspiration in acute stroke patients and could be used to predict length of ICU stay and mortality.

Keyword

aspiration; dysphagia; penetration; pneumonia; stroke; swallowing

Figure

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  Figure 1. Correlation between penetration-aspiration scale (PAS) levels with Glasgow coma score (GCS). aSpearman correlation.

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  Figure 2. Correlation between penetration-aspiration scale (PAS) levels with Full Outline of UnResponsiveness (FOUR) score. aSpearman correlation.

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  Figure 3. Correlation between penetration-aspiration scale (PAS) levels with National Institutes of Health Stroke Scale (NIHSS). aSpearman correlation.

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  Figure 4. Receiver operating characteristic curve for penetration-aspiration scale level to predict incidence of hospital-acquired pneumonia. AUC: area under the curve.

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  Figure 5. Receiver operating characteristic curve for penetration-aspiration scale level to predict intensive care unit stay more than 7 days. AUC: area under the curve.

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  Figure 6. Receiver operating characteristic curve for penetration-aspiration scale level to predict mortality. AUC: area under the curve.

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