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

BMC Med Educ. 2009 Mar 10:9:13. doi: 10.1186/1472-6920-9-13.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

MeSH terms

  • Adult
  • Clinical Competence
  • Clinical Protocols*
  • Deglutition / physiology*
  • Deglutition Disorders / diagnosis*
  • Deglutition Disorders / etiology
  • Deglutition Disorders / physiopathology
  • Educational Measurement / methods
  • Endoscopy / education*
  • Endoscopy / methods
  • Endoscopy / standards
  • Female
  • Fiber Optic Technology*
  • Humans
  • Laryngoscopy / methods
  • Laryngoscopy / standards
  • Male
  • Neurology / education*
  • Neurology / standards
  • Observer Variation
  • Reproducibility of Results
  • Respiratory Aspiration / diagnosis*
  • Respiratory Aspiration / etiology
  • Respiratory Aspiration / physiopathology
  • Saliva / metabolism
  • Stroke / complications*
  • Stroke / physiopathology
  • Video Recording