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Dysphagiediagnostik und -therapie des akuten Schlaganfalls

Eine bundesweite Erhebung auf zertifizierten Stroke-Units

Dysphagia diagnostics and therapy of acute stroke

Federal survey of certified stroke units

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Zusammenfassung

Hintergrund

Die Dysphagie als Schlaganfallsymptom ist infolge von Mangelernährung und Aspirationspneumonie mit einer erhöhten Morbidität und Mortalität assoziiert. Die rechtzeitige Identifikation und gezielte Behandlung von Risikopatienten verbessert das Outcome.

Methoden

Durch schriftliche Befragung wurde der gegenwärtige Stand der Dysphagiediagnostik und -therapie auf zertifizierten deutschen Stroke-Units erhoben.

Ergebnisse

Von 163 angeschriebenen Kliniken nahmen 51% an der Umfrage teil. Davon haben 94% ein standardisiertes Dysphagiekonzept etabliert, dessen Durchführung mehrheitlich (64%) den Logopäden obliegt. Hauptelemente sind pflegerische Schluckassessments (72%) und die klinisch-logopädische Schluckuntersuchung (93%). Über apparative Diagnostik verfügen 55%, wobei die Videoendoskopie (52%) weiter verbreitet ist als die Videofluoroskopie (17%). Die Therapie in der Akutphase erfolgt überwiegend durch Kostanpassung.

Schlussfolgerung

Insgesamt sind Strukturen zur Dysphagiediagnostik und -therapie vorhanden, die individuellen Strategien jedoch heterogen und Unterschiede in der Versorgungsqualität deutlich erkennbar.

Summary

Background

Due to malnutrition and aspiration pneumonia dysphagia is associated with increased morbidity and mortality in acute stroke patients. Early detection of patients at risk of dysphagia leading to timely treatment improves the outcome.

Methods

A survey concerning the current state of dysphagia diagnostics and therapy was carried out among certified stoke units in Germany.

Results

Of the 163 invited hospitals 51% participated in the study. A standardized dysphagia program lying mainly within the responsibility of speech language therapists (64%) is established in 94%. Main elements are swallowing assessments carried out by nurses (72%) and the clinical swallowing examination (93%). Instrumental diagnostics are available in 55% with videoendoscopy (52%) being more widely used than videofluoroscopy (17%). In the acute stage nutrition with texture modified diets is the primary therapeutic strategy.

Conclusions

Structured programs for the diagnosis and treatment of dysphagia have generally been established but individual strategies differ and differences in the quality of care are obvious.

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Interessenkonflikt

Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht.

Danksagung

Wir danken den Leitern und Mitarbeitern aller neurologischen Abteilungen, die an dieser Umfrage teilgenommen haben.

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Authors and Affiliations

  1. Klinik für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus, Münster, Deutschland

    S. Suntrup & R. Dziewas

  2. Klinik für Neurologie, Centrum für Schlaganfallforschung, Charité-Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Deutschland

    A. Meisel & P. Heuschmann

  3. Klinik für Neurologie & Stroke Unit mit Dysphagiezentrum, HELIOS Klinikum Aue, Technische Universität Dresden, Gartenstr. 6, 08280, Aue, Deutschland

    F. Ende &  G.W. Ickenstein

  4. Klinik und Poliklinik für Neurologie, Carl Gustav Carus Universitätsklinikum Dresden, Dresden, Deutschland

    H. Reichmann

Authors
  1. S. Suntrup
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  2. A. Meisel
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  3. R. Dziewas
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  4. F. Ende
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  5. H. Reichmann
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  6. P. Heuschmann
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  7. G.W. Ickenstein
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Corresponding author

Correspondence to G.W. Ickenstein.

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Suntrup, S., Meisel, A., Dziewas, R. et al. Dysphagiediagnostik und -therapie des akuten Schlaganfalls. Nervenarzt 83, 1619–1624 (2012). https://doi.org/10.1007/s00115-012-3611-9

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