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Dysphagia is common after stroke, presenting in 55% of all hospital-admitted patients with acute disease, and, de - pending on the lesion site and volume, can linger as a chronic problem for years.1 It is estimated that every year in Canada there are 21 000 new elderly patients with dysphagia after stroke and 200 000 in the United States.2 Of these patients, as many as 10 000 in Canada and 100 000 in the US continue to experience dysphagia for months after the initial stroke event. The problem of dysphagia after stroke is ex pected to increase given the aging of our population.
Dysphagia after stroke is often underdiagnosed. 3 Dysphagia needs to be detected early and managed effectively because the consequences of untreated dysphagia could be serious.2,4 Dysphagia has been associated with increased length of stay, malnutrition, dehydration and death.5 Reports of pneumonia in patients with dysphagia after stroke range from 7% to 33%, with conservative estimates at 18%.1 Patients with dysphagia after stroke have a 3-fold increased risk for aspir - ation pneumonia, and this risk is markedly in - creased to 11-fold in patients with confirmed aspiration on videofluoroscopy after stroke.1 As - piration without a cough (silent aspiration) further increases the incidence of pneumonia to 54%.6 This is problematic considering that silent aspiration occurs in up to two-thirds of patients with dysphagia after stroke.7
Evidence-based tools are now available to detect dysphagia early, even in patients with silent aspiration. New stroke guidelines in Canada are stressing early detection of dysphagia with validated screening tools.8 Similar guidelines exist in the US9 and the United Kingdom.10 These guidelines require that a trained clinician screen patients admitted with stroke or suspicion of stroke for dysphagia as soon as the patients are alert and able. A standardized tool must be used.
In an effort to standardize care for patients with stroke across all settings, the Toronto Bedside Swallowing Screening Test was recently developed. 11 The test was conceptualized and developed on the premise that earlier detection of dysphagia by screening shortens the time to recovery and also improves overall patient health.2
There is now emerging evidence from one retrospective study to show that early detection of dysphagia reduces subsequent pulmonary complications in patients with stroke...