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. 2010 Sep;257(9):1492-9.
doi: 10.1007/s00415-010-5558-8. Epub 2010 Apr 10.

Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept

G W Ickenstein  1 , A Riecker, C Höhlig, R Müller, U Becker, H Reichmann, M Prosiegel
Affiliations

Pneumonia and in-hospital mortality in the context of neurogenic oropharyngeal dysphagia (NOD) in stroke and a new NOD step-wise concept

G W Ickenstein et al. J Neurol. 2010 Sep.

Abstract

The aim of our work was to develop a step-wise concept for investigating neurogenic oropharyngeal dysphagia (NOD) that could be used by both trained nursing staff as well as swallowing therapists and physicians to identify patients with NOD at an early stage and so enable an appropriate therapy to be started. To achieve this objective, we assessed uniform terminology and standard operating procedures (SOP) in a new NOD step-wise concept. In-house stroke mortality rates and rates of pneumonia were measured over time (2003-2009) in order to show improvements in quality of care. In addition, outcome measures in a stroke-unit monitoring system were studied after neurorehabilitation (day 90) assessing quality of life (QL) and patient feedback. An investigation that was carried out in the context of internal and external quality assurance stroke projects revealed a significant correlation between the NOD step-wise concept and low rates of pneumonia and in-house mortality. The quality of life measures show a delta value that can contribute to "post-stroke" depression. The NOD step-wise concept (NSC) should, on the one hand, be capable of being routinely used in clinical care and, on the other, being able to fulfil the requirements of being scientifically based for investigating different stages of swallowing disorders. The value of our NSC relates to the effective management of clinical resources and the provision of adequate diagnostic and therapeutic options for different grades of dysphagia. We anticipate that our concept will provide substantial support to physicians, as well as swallowing therapists, in clinical settings and rehabilitation facilities, thereby promoting better guidance and understanding of neurogenic dysphagia as a concept in acute and rehabilitation care, especially stroke-unit settings.

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Figures

Fig. 1
Fig. 1
Modified swallowing assessment (MSA) for nursing staff (for more details concerning the NOD step-wise concept (NSC) please visit the website: http://www.helios-kliniken.de/klinik/aue/fachabteilungen/neurologie/neurogene-dysphagie.html)
Fig. 2
Fig. 2
In-hospital pneumonia and stroke mortality rate from 2003 to 2009 showing the relationship over the years between in-house stroke mortality rate (%) and the opening of the Department of Neurology (1), the opening of the Stroke Unit (2), and the introduction of an NOD step-wise concept (3) to reduce the rate of pneumonia and malnutrition with an structured dysphagia program
See this image and copyright information in PMC

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