Medication Administration in Poststroke Dysphagia: Evaluating Swallowing Safety of Solid Dosage Forms

Area of Science:

• Neurology
• Gastroenterology
• Pharmacology

Background:

• Poststroke dysphagia affects up to 75% of patients, necessitating standardized screening.
• Current guidelines recommend medication assessment, but lack validated tools for solid dosage forms (SDFs).
• Crushing tablets is common practice to reduce aspiration risk, yet its safety and efficacy remain unevaluated.

Purpose of the Study:

• To compare the safety and efficiency of swallowing crushed versus whole placebo tablets in acute stroke patients.
• To evaluate the risk of aspiration and pharyngeal residue associated with different solid dosage form (SDF) administration methods.
• To provide instrumental evidence for guiding safe medication administration in dysphagic stroke patients.

Main Methods:

• A prospective, single-center, cross-sectional study involving 60 acute stroke patients.
• Fiberoptic Endoscopic Evaluation of Swallowing (FEES) was used to assess swallowing of 1 crushed and 3 whole placebo tablets with applesauce.
• Primary outcome: incidence of unsafe swallowing (Penetration-Aspiration Scale); Secondary outcomes: pharyngeal residue presence and location.

Main Results:

• All 154 fully swallowed whole tablets were safe; no penetration or aspiration occurred.
• Unsafe swallowing occurred in 14.3% of accompanying boli and 12.1% of crushed SDFs, with no significant difference.
• Crushed SDFs led to significantly more vallecular residues (P<0.001).

Conclusions:

• Routine crushing of SDFs for dysphagic stroke patients should be reconsidered.
• Whole SDFs, when deemed safe via FEES, may be a preferable alternative.
• Utilizing FEES can guide safer medication administration, potentially improving efficacy and reducing errors.