Dysphagia Screening Post-Stroke: Systematic Review

BMJ Supportive & Palliative Care

Mancin, S., Sguanci, M., et al. (2023).

BMJ Supportive & Palliative Care, 13(e3), e641-e650.

This systematic review investigates the diagnostic accuracy of dysphagia screening tools for individuals with chronic stroke-associated dysphagia.

None declared

January 1, 2000 to November 30, 2022

Primary studies of any design

10

<div>The following findings, ranked by diagnostic accuracy, were reported for dysphagia screening tools for individuals with chronic stroke-associated dysphagia:</div> <ul> <li><strong>Volume-Viscosity Swallow Test (V-VST):</strong> Three studies reported sensitivity ranging from 83.3% to 96.6% and specificity ranging from 71.4% to 72.6%. Pooled analysis yielded a sensitivity of 91.75% (95% CI: 84.1% to 96.3%) and a specificity of 72.2% (95% CI: 62.5% to 81.0%).</li> <li><strong>Yale Swallow Protocol:</strong> One study reported a<strong> </strong>sensitivity of 95.4%, specificity of 66.9%, positive predictive value of 77.7%, and negative predictive value of 92.4%.</li> <li><strong>Italian version of the Royal Brisbane and Women's Hospital dysphagia screening tool (I-RBWH):</strong> One study reported a sensitivity of 93%, specificity of 96%, positive predictive value of 90%, and negative predictive value of 97%.&nbsp;</li> <li><strong>Standardised Swallowing Assessment (SSA):</strong> One study reported a sensitivity of 94.5% and specificity of 65%.&nbsp;</li> <li><strong>Gugging Swallowing Screen (GUSS):</strong> One study reported a sensitivity of 89.5%, specificity of 87.5%, positive predictive value of 89.5%, and negative predicative value of 87.5%.&nbsp;</li> <li><strong>Water Swallowing Test (WST):</strong> One study reported a sensitivity of 72% and specificity of 67%.</li> <li><strong>Saliva Swallowing Test:&nbsp;</strong>One study reported a sensitivity of 28% and specificity of 76%.</li> </ul> <div>Overall, the V-VST was found to be most supported dysphagia screening tool for individuals with chronic stroke-associated dysphagia. This was due to high reported accuracy when compared to gold-standard assessment (i.e., videofluoroscopic swallow study) and investigation across multiple studies with an overall large sample size. The best time to administer these screening tools was found to be "immediately upon taking charge of the patient or in the first 24 hours after accessing the residential care" (p. e646). Further research is needed due to an overall paucity of studies investigating each individual screening tool.</div>