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Swallow Screening as an Essential Component of Acute Stroke Management (pp. 69-88) $100.00
Authors:  (Julie Luker, Kylie Wall, International Centre for Allied Health Evidence, University of South Australia, Adelaide, South Australia)
Dysphagia following stroke is common and increases patient risk of
poor outcomes and adverse events. Swallow screening is an important
process of care for patients who suffer acute stroke. This brief
examination aims to identify those patients that may be at risk of
swallowing problems so that comprehensive assessment and management
can be provided. However, despite wide agreement that swallow
screening is an essential component of care, there is no agreement
regarding how or when screening should be performed, and by whom.
Debate continues regarding the validity and reliability of various
screening tools, and whether they are able to provide an acceptable level
of certainty in risk detection. Our chapter reviews the current evidence
underpinning swallow screening for acute stroke patients.
Published clinical quality audits on acute stroke populations have
reported suboptimal compliance with swallow screening. Current
evidence suggests that multiple factors contribute to screening
compliance, including the structures and systems within health care
facilities, such as stroke unit care. The provision of swallow screening
may also be influenced by demographic and stroke-related variables of
the patients themselves, such age, gender and stroke severity.
The results of the authors‟ recent research on the factors that
influence the quality of stroke swallow screening will be presented. This
was conducted in three Australian tertiary hospitals. The study
retrospectively audited the care provided to 300 patients admitted with
acute stroke. Data was collected on swallow screen compliance and other
variables of interest including stroke unit admission, day of admission,
patients‟ age, gender, English proficiency, comorbidities, pre-stroke
levels of independence and type of accommodation, stroke severity and
length of stay. Logistical univariate and multivariate stepwise regression
analysis was undertaken to explore the determinants of screening
compliance in this population. In the sample, patients with milder stroke,
and those admitted over a weekend, were at increased risk of not
receiving a swallow screen.
Swallow screening is an accepted care process in acute stroke
management, despite ongoing debate regarding the best way to conduct
the screening. Studies, including our own, report suboptimal provision of
swallow screening. The factors that influence swallow screening
compliance may be complex and include variables within hospital
systems, as well as variables related to the patient and their stroke. 

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Swallow Screening as an Essential Component of Acute Stroke Management (pp. 69-88)