Diagnosis and Initial Treatment of Ischemic Stroke
Anderson, D., Larson, D., et al. (2010).
Bloomington (MD): Institute for Clinical Systems Improvement, (10th edition), 67.
This guideline provides recommendations for the diagnosis and initial treatment of ischemic stroke. The primary intended audiences for this guideline are health professionals, provider organizations, policy makers, and benefit managers.
Institute for Clinical Systems Improvement
If a swallow screening is positive for individuals diagnosed with stroke, a bedside water swallow test should be performed with 2-3 ounces of water. If clinical signs of aspiration are observed during the bedside swallow evaluation using a water swallow test, the patient should not receive anything by mouth, and should be referred to a speech language pathologist for a formal swallow evaluation.
It is recommended that patients diagnosed with ischemic stroke receive a bedside swallow test prior to the ingestion of anything by mouth, including medications (Class C Evidence).
"Bedside swallow assessment or a more formal swallow evaluation, and dietary adjustments based on this information, have not been adequately evaluated in sufficiently powered randomized clinical trials. Because these interventions are safe and have a reasonable probability of improving care by decreasing complications, it is reasonable to advocate their use in this setting despite absence of proof of efficacy. Several previously published guidelines advocate these practices" (Class M Evidence; p. 40).
The guideline group recommends a swallow screen be performed in the emergency department by a physician or nurse for individuals diagnosed with ischemic stroke (Class C Evidence).
