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Fluids & Electrolytes
The objective of the study was to assess the level of agreement between the registered dietitian (RD) and the speech-language pathologist (SLP) regarding the determination of dysphagia risk and diet order in hospitalized stroke patients and to determine predictors of dysphagia that the RD can use to effectively identify individuals in this population. In this prospective single-blinded study of 32 patients admitted to the hospital stroke team, the RD used a dysphagia screening tool. Results were compared to the bedside swallowing evaluation by an SLP to assess the level of agreement on dysphagia risk and diet recommendations. Demographic data, nutrition risk, and MD and RN documentation of dysphagia risk factors were compared utilizing frequency distributions (JMP-In, alpha P = .05). The statistic was used to assess agreement regarding dysphagia risk, diet consistency, and liquid restrictions. Logistical regression was used to identify the best predictors of dysphagia risk. The RD identified 40.6% of patients (n = 13) and the SLP identified 31.3% of patients (n = 10) as being at risk for dysphagia. There was excellent agreement (k = 0.80) on determination of dysphagia risk, perfect agreement (k = 1.00) on order for oral diet (p.o. vs n.p.o.), excellent agreement on ability to take liquids (k = 0.83), and very good agreement on types of solid diet orders (k = 0.79). An abbreviated dysphagia screening tool was designed as a result of regression analysis. This study demonstrated that the RD can effectively identify dysphagia risk and has a role in screening acute stroke patients for dysphagia. Incorporating dysphagia screening as part of standard nutritional care expands the role of the RD, and benefits stroke patients by early identification and intervention.
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