The secretion severity rating scale: A potentially useful tool for management of acute-phase fasting stroke patients

This retrospective clinical investigation was conducted to evaluate the usefulness of the Secretion Severity Rating Scale (Secretion Scale) in predicting the risk of pneumonia in acute-phase fasting stroke patients. Videoendoscopic (VE) evaluation of swallowing was performed in 72 consecutive stroke patients with a nonoral status. The patients were classified into 2 groups based on the Secretion Scale: the pharyngeal residual group (n = 38; Secretion Scale level 0, 8 [11.1%]; level 1, 30 [41.7%]) and the laryngeal residual group (n = 34: Secretion Scale level 2, 13 [18.1%]; level 3, 21 [29.2%]). The higher the Secretion Scale score, the more severe the swallowing dysfunction. The results of the evaluation were compared with the frequency of aspiration as well as with the incidence of pneumonia in the period from VE examination to discharge. In addition, the incidence of pneumonia was compared in the aspiration-positive and aspiration-negative groups. After VE evaluation, 4 patients (10.5%) in the pharyngeal residual group developed pneumonia versus 12 (35.3%) in the laryngeal residual group; the incidence of pneumonia was significantly higher in the laryngeal residual group (P < .05; Fisher's exact test). Our data indicate that the Secretion Scale can be a useful risk-management tool for predicting pneumonia in acute-phase fasting stroke patients.