Detection of eating difficulties after stroke: a systematic review

Background: It is highly important in nursing care for persons with stroke to screen for, assess and manage eating difficulties. The impact on eating after stroke can be of different types, comprising dysphagia as well as eating difficulties in a larger perspective. Eating difficulties can cause complications such as malnutrition, dehydration, aspiration, suffocation, pneumonia and death. There is a lack of systematic reviews about methods to be used by nurses in their screening for eating difficulties. Aim: This review aims at systematically capturing and evaluating current peer-reviewed published literature about non-instrumental (besides pulse oximetry) and non-invasive screening methods for bedside detection of eating difficulties among persons with stroke. Methods: A search was performed in Medline and 234 articles were obtained. After a selection process 17 articles remained, covering seven screening methods and including about 2000 patients. Conclusion: Best nursing practice for detecting eating difficulties includes as the first step the Standardized Bedside Swallowing Assessment (SSA) to detect dysphagia (strong evidence). As the second step an observation should be made of eating including ingestion, deglutition and energy (moderate evidence). Applying pulse oximetry simultaneously to SSA can possibly add to the accuracy of aspiration detection, especially silent aspiration (limited evidence). The methods should be used as a complement to interviews.