Post-stroke dysphagia: An exploration of initial identification and management performed by nurses and doctors.
Maggie Pierpoint, Mershen Pillay
PMID 32501033WHAT IT FOUND
Nurses and doctors mostly used informal observation to spot swallowing problems, often missing key signs like voice changes or voluntary cough.
They also reported using unsafe practices like syringe feeding and prescribing exercises outside their scope. This highlights a need for better training and formal screening tools.
Key findings
01Most doctors and nurses did not use a formal screening tool, relying instead on informal observation.
02Participants frequently relied on the gag reflex, which has low sensitivity and specificity for dysphagia, while neglecting important signs like voluntary cough and vocal quality.
03Management practices included potentially harmful methods such as syringe feeding and total parenteral nutrition, as well as prescribing rehabilitation exercises which are outside their scope of practice.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study was conducted at a single private hospital, limiting generalizability to public sector settings. The response rate was low (33.78%), introducing potential selection bias. Data was self-reported, which may be influenced by social desirability bias and may not reflect actual clinical practice. The study did not collect data on the timing of screening, which is a critical factor in pneumonia risk. The questionnaire was developed for this study, though it was piloted.
Declared interests
No specific funding source or conflict of interest declaration is provided in the text, but the study was part of a master's degree project.
The easy way to misread this
Do not interpret the high referral rate to SLTs as evidence that the system is working safely. The study shows that before referral, doctors and nurses are often using unsafe practices like syringe feeding and relying on poor screening signs, which may delay accurate identification or cause harm.