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This prospective cohort study evaluates clinical indicators to prioritize swallowing assessments in the emergency room and enable earlier, safer return to oral feeding. One hundred thirty-four postacute ischemic stroke patients were stratified by dysphagia risk and assessed with DREP and ASHA-NOMS, with a VFSS subset. Older age, higher NIHSS severity, alternative feeding needs, and coughing during a 50-ml water swallow test predicted aspiration risk.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/key-indicators-for-prioritizing-swallowing-assessment-in-acute-ischemic-stroke-patients-in-the-emergency-room/435976/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/key-indicators-for-prioritizing-swallowing-assessment-in-acute-ischemic-stroke-patients-in-the-emergency-room/435976.png","ImageObject",300,407,{"name":92,"@type":93},"Emma Wilson","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What was the study objective regarding swallowing assessment in the emergency room?","Question",{"text":112,"@type":113},"To identify clinical indicators that help prioritize swallowing assessments in the emergency room for acute ischemic stroke patients, supporting faster and safer resumption of oral feeding.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How were patients assessed for swallowing function and dysphagia risk?",{"text":117,"@type":113},"Swallowing function was evaluated using the Dysphagia Risk Evaluation Protocol (DREP) and the ASHA-NOMS scale, with a subset undergoing video-fluoroscopic swallowing study (VFSS).",{"name":119,"@type":110,"acceptedAnswer":120},"Which indicators were identified as predictors of aspiration risk?",{"text":121,"@type":113},"Age (≥69), higher NIHSS scores (≥9), the need for alternative feeding methods, and coughing during the 50-ml water swallow test were key predictors.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},435976,1790789920,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},3848291630094,"https://eur-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45","Article published online: 2025-11-21  \nOriginal Article 1  \nKey indicators for prioritizing swallowing assessment in acute ischemic stroke patients in the emergency room  \nKaroline Kussik de Almeida Leite 1 Fernanda Chiarion Sassi2 Ana Paula Ritto2 Claudia Regina Furquim de Andrade2  \n1 Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Miologia Oral, São Paulo SP, Brazil.  \n2 Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional, São Paulo SP, Brazil.  \nArq. Neuro-Psiquiatr. 2025;83(11):s00451812891 .  \nAddress for correspondence Claudia Regina Furquim de Andrade (email: [clauan@usp.br](clauan@usp.br))  \nAbstract  \nKeywords  \n► Dysphagia  \n► Stroke  \n► Deglutition  \n► Suction  \n► Neurology  \nBackground Stroke is a major cause of mortality and disability globally. Dysphagia is a frequent complication that increases the risk of aspiration pneumonia, a key contributor to stroke-related deaths. Early screening is essential for improving outcomes.  \nObjective To identify clinical indicators that can help prioritize swallowing assessments in the emergency room, enabling faster and safer resumption of oral feeding. Methods A prospective cohort of 134 postacute ischemic stroke patients admitted to the emergency room was assessed. Patients were divided into 2 groups: G1 (at risk of dysphagia) and G2 (no risk) . Swallowing function was evaluated using the Dysphagia Risk Evaluation Protocol (DREP) and the American Speech-Language-Hearing Association National Outcomes Measurement System (ASHA-NOMS) scale. A subset (n ¼ 15) underwent videofluoroscopic swallowing study (VFSS) . Stroke severity was measured using the National Institutes of Health (NIH) stroke scale (NIHSS) . Statistical analyses included t-tests, Chi-squared test, Pearson’s correlation, and Cochran’s Q test (p \u003C0.05) .  \nResults Patients from G1 were older (mean: 69.1 vs. 63.0 years, p ¼ 0.023), had more severe strokes (NIHSS 􀀂 9.8, p ¼ 0.002), and were more likely to require alternative feeding methods. Older age and longer hospital stays correlated with increased dysphagia risk. Coughing during the 50-ml water swallow test was a strong predictor of aspiration.  \nConclusion Key indicators of aspiration risk in postacute ischemic stroke patients include age 􀀂 69, NIHSS score 􀀂 9, and the need for alternative feeding. Coughing during the water swallow test is a valuable clinical predictor. Early identification can support targeted interventions and reduce complications.  \nreceived  \nMarch 31, 2025 received in its final June 30, 2025 accepted September 7, 2025  \nDOI [https://doi.org/](https://doi.org/)[ ](https://doi.org/)10.1055/s-0045-1812891 . ISSN 0004-282X.  \nEditor-in-Chief: Ayrton Roberto Massaro.  \nAssociate Editor: Marcos Christiano Lange.  \n© 2025 . The Author(s) .  \nThis is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit ([https://creativecommons.org/licenses/by/4.0/](https://creativecommons.org/licenses/by/4.0/))  \nThieme Revinter Publicações Ltda. , Rua Rego Freitas, 175, loja 1, República, São Paulo, SP, CEP 01220-010, Brazil  \n2 Swallowing assessment for acute stroke Leite et al.  \nINTRODUCTION  \nStroke is the second leading cause of mortality and disability worldwide, and in Brazil, it is the leading cause of death and disability, making it one of the most significant public health challenges in the country. 1,2 In Brazil, between January and November 2024, around 177,590 individuals were hospitalized due to stroke, with 25,207 recorded deaths, reinforcing its position as the primary cause of mortality and disability in the country.3,4  \nAdvanced age is strongly associated with poorer functional recovery after ischemic stroke, including greater impairment in swallowing, mobility, and","cbCaij1HxAZQC8Ow","https://ap.wps.com/l/cbCaij1HxAZQC8Ow","pdf",1027897,"English","# Background\n# Objective\n# Methods\n## Participants and groups\n## Assessment tools and outcomes\n# Results\n# Conclusion","[{\"question\":\"What was the study objective regarding swallowing assessment in the emergency room?\",\"answer\":\"To identify clinical indicators that help prioritize swallowing assessments in the emergency room for acute ischemic stroke patients, supporting faster and safer resumption of oral feeding.\"},{\"question\":\"How were patients assessed for swallowing function and dysphagia risk?\",\"answer\":\"Swallowing function was evaluated using the Dysphagia Risk Evaluation Protocol (DREP) and the ASHA-NOMS scale, with a subset undergoing video-fluoroscopic swallowing study (VFSS).\"},{\"question\":\"Which indicators were identified as predictors of aspiration risk?\",\"answer\":\"Age (≥69), higher NIHSS scores (≥9), the need for alternative feeding methods, and coughing during the 50-ml water swallow test were key predictors.\"}]","Key indicators for prioritizing swallowing assessment in acute ischemic stroke patients in the emergency room | PDF",1790676207]