Utility of modified Mann assessment of swallowing ability (MMASA) in predicting aspiration risk and safe swallow in stroke patients

Nittu Devassy Panjikaran; Rajalakshmi Iyer; Remya Sudevan; Renjitha Bhaskaran

doi:10.4103/jfmpc.jfmpc_1628_21

Utility of modified Mann assessment of swallowing ability (MMASA) in predicting aspiration risk and safe swallow in stroke patients

J Family Med Prim Care. 2022 Sep;11(9):5123-5128. doi: 10.4103/jfmpc.jfmpc_1628_21. Epub 2022 Oct 14.

Authors

Nittu Devassy Panjikaran¹, Rajalakshmi Iyer², Remya Sudevan³, Renjitha Bhaskaran⁴

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
² Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
³ Department of Medical Research, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
⁴ Department of Biostatistics, Amrita Institute of Medical Sciences, Cochin, Kerala, India.

Abstract

Introduction: Aspiration pneumonia is one of the commonest causes of post-stroke mortality. We may be able to reduce this morbidity and mortality by assessing the risk of aspiration in stroke patients. Assessment of this risk can be done using a physician-administered screening protocol to assess dysphagia. A score of ≥95 is a good cut off to detect patients who can take oral feeds safely.

Objectives: The primary objective was to predict aspiration risk using the Modified Mann Assessment Swallowing Ability (mMASA) scale. The secondary objective was to predict the safety of oral feeds using the same scale.

Materials and methods: An analytical cross-sectional study was conducted at a tertiary care rehabilitation centre in South India. A total of 100 stroke patients who underwent stroke rehabilitation in the study institution were divided into patients who were able to eat orally or not based on the mMASA scale. Demographic and stroke characteristics were recorded. The mMASA score was calculated and those with a score of ≥95 were given oral feeds. Those who scored <95 were given swallow therapy and re-evaluated in 2 weeks. Also, the mMASA score below which the patient was likely to develop aspiration pneumonia was detected using the receiver operating characteristic curve (ROC).

Results: Out of the 100 patients, 37 patients had a score of ≥95 and were started on oral feeds and had no complications; the rest were started on 2 weeks of swallow therapy. On re-evaluation after swallow therapy, 12 more were started on oral feeds. The remaining 51 patients did not reach the cut-off score of ≥95 and were continued on nasogastric tube feeding. A total of 11 patients developed features of aspiration pneumonia; all of them belonged to the group of 51 patients who consistently had a mMASA score <95. The ROC curve determined that a score of <89 was a good cut off to predict patients who are at high risk of aspiration.

Conclusion: The scale can be used to predict the likelihood of aspiration and readiness to start oral feeds in sub-acute stroke patients.

Keywords: Aspiration pneumonia; dysphagia screening; stroke outcome.