Screening for Dysphagia and Aspiration in Acute Stroke: A Systematic Review
Dysphagia
Perry, L., & Love, C. P. (2001).
Dysphagia, 16(1), 7-18.
This systematic review investigates the effect of clinical dysphagia screening (e.g., The Burke Dysphagia Screening Test, Standardized Swallowing Assessment, bedside swallowing assessments) on patient outcomes in adults experiencing acute stroke.
South Thames Research and Development Directorate of the Department of Health (United Kingdom)
Up to September 1999
English-language studies (not further specified)
26
[The Standardized Swallowing Assessment (SSA)] performed better than the 3-oz water swallow test in determining relative risk of lower respiratory tract infection. However, the SSA was reportedly less sensitive than the Burke Dysphagia Screening Test, a 50ml water swallow test.
Compared to the Hinds and Wiles Timed Test and the Bedside Swallowing Assessment, [the Standardized Swallowing Assessment (SSA)] demonstrated the lowest percentage of unassessable patients suggesting its relative clinical utility in screening patients for suspected dysphagia. Additionally, the SSA was the only tool with published reliability data.
Only two studies examined the use of protocols for the screening and management of dysphagia post stroke. Tests included the Standardized Swallowing Assessment and the 50 ml drinking test. The authors concluded that "both demonstrated positive outcomes in terms of identification of [swallowing] problems, appropriateness of referral and management, and/or reduced incidence of lower respiratory tract infection" (p. 14).
<p>The following clinical screening methods were identified in the literature and reported roughly the same sensitivity and specificity rates for identifying dysphagia and aspiration risk for individuals diagnosed with acute stroke:</p>
<ul>
<li>clinical examination (presentation of any two clinical signs of swallowing problems);</li>
<li>water swallow tests (e.g., Burke Dysphagia Screening Test);</li>
<li>Standardized Swallowing Assessment;</li>
<li>the timed test of Hinds and Wiles; and</li>
<li>Bedside Swallowing Assessment.</li>
</ul>
<p>Four screening tools used [videofluoroscopic swallow study (VSS)] as the gold standard. However, limited standardization as well as other factors such as radiation exposure and positioning during VSS should be considered. Further validation and reliability testing of dysphagia screening tools is warranted.</p>
Use of pulse oximetry as a screening tool for identification of aspiration could not be determined.
