ESPEN 2013 - Late breaking abstract submission

Late Breaking Abstract

ESPEN13-1815

TELEDYSPHAGIA FOR ACUTE STROKE PATIENTS USING A STANDARDIZED EXAMINATION KIT IN A TELESTROKE NETWORK

J. Höhlig ^1,* on behalf of TELE-DIAS study groupA. Czekanska ¹C. Höhlig ¹H. J. Koch ²H. Reichmann ³G. W. Ickenstein ¹

¹Department of Neurology, ²Department of Psychiatry, Helios General Hospital Aue, Technical University Dresden, Aue, ³Department of Neurology, Carl Gustav Carus University Hospital, Dresden, Germany

Rationale: Since 2006, the Teleneuromedicine Stroke Network in Southwest Saxony was established to implement a fast access to stroke thrombolysis. Nowadays, this mission is nearly completed and thrombolysis rates reached a more acceptable level. The focus of our technical approach is now to bridge a telesupervised dysphagia concept to the satellite partner hospitals in the telenetwork to early detect aspiration signs and establish a safer nutrition.

Methods: Our TELE-DIAS study included acute stroke patients with signs of aspiration in the modified swallowing assessment. They were observed with a telemedicine approach using a standardized protocol for the clinical swallowing examination (CSE) and a flexible transnasal swallowing examination (FEES). During the CSE and the FEES, a standardized examination kit with ready-to use products of different viscosities were used to detect aspiration signs and to find a suitable texture modified diet (TMD).

Results: Acute stroke patients (n=34) were examined with CSE and in addition with FEES. In 68% the swallowing therapist suspected signs of aspiration in the CSE. After tele-FEES was performed by a medical doctor, this suspicion was confirmed only in 43% of the patients. The medical doctor recommended a nasogastric tube for 33% of severe dysphagic patients while for the others, a therapeutic feeding protocol with TMD could be initiated.

Conclusion: CSE has a high sensitivity but a low specificity to detect patients with aspiration. Consequently, the combination of CSE and FEES can be highly recommended even in a new teledysphagia approach using standardized examination kits. A tele-supervised FEES supports the medical doctor in a satellite partner hospital in the decision for or against nasogastric tube feeding. Within a telestroke network, the dysphagia expert is able to observe the pathological findings and assist with a standardized protocol to find the suitable TMD.

Disclosure of Interest: None Declared

Keywords: dysphagiatelemedicine