Towards a basic endoscopic evaluation of swallowing in acute stroke - identification of salient findings by the inexperienced examiner

• Published in: BMC medical education Vol. 9; no. 1; p. 13
• Main Authors: Warnecke, Tobias, Teismann, Inga, Oelenberg, Stephan, Hamacher, Christina, Ringelstein, E Bernd, Schäbitz, Wolf R, Dziewas, Rainer
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10-03-2009; BioMed Central; BMC
• Subjects: Adult; Care and treatment; Clinical Competence; Clinical Protocols; Deglutition - physiology; Deglutition disorders; Deglutition Disorders - diagnosis; Deglutition Disorders - etiology; Deglutition Disorders - physiopathology; Diagnosis; Educational Measurement - methods; Endoscopy - education; Endoscopy - methods; Endoscopy - standards; Evaluation; Female; Fiber Optic Technology; Humans; Laryngoscopy - methods; Laryngoscopy - standards; Male; Medical protocols; Neurology - education; Neurology - standards; Observer Variation; Prevention; Reproducibility of Results; Respiratory Aspiration - diagnosis; Respiratory Aspiration - etiology; Respiratory Aspiration - physiopathology; Risk factors; Saliva - secretion; Stroke (Disease); Stroke - complications; Stroke - physiopathology; Germany
• ISSN: 1472-6920; 1472-6920
• DOI: 10.1186/1472-6920-9-13

Dysphagia is common after stroke. Fiberoptic endoscopic evaluation of swallowing (FEES) is a powerful tool for dysphagia assessment. The purpose of this study was to assess whether a previously established endoscopic examination protocol based on the identification of typical findings indicative of stroke - related dysphagia may be learned and adopted by clinicians so far inexperienced in this field.
After receiving a structured lecture on this topic, participants were asked to rate video sequences of endoscopic swallowing examinations of acute stroke patients. The first part of the testing ("single findings-rating") comprised of 16 single sequences, the second part ("complete examination-rating") presented the key sequences of 8 complete examinations. Before the second part was started, results of the first were discussed.
At the "single findings-rating" 88.8% of video-sequences were assessed correctly, while at the "complete examination-rating" the average performance had improved to 96%. Furthermore, no overlooking of relevant pathologies was noted in the second part of the testing.
This study suggests that the presented endoscopic examination protocol is reliably interpreted by inexperienced clinicians after a short lecture and may therefore easily and successfully be adopted in dysphagia management of acute stroke care.