Nurse’s Bedside Screening of Dysphagia: An Umbrella Review
Recenti Progressi in Medicina
Rosa, D., Albanesi, B., et al. (2022).
Recenti Progressi in Medicina, 113(6), 361-371.
This umbrella review of systematic reviews aims to locate the most valid, reliable, and usable bedside screening tools for identifying dysphagia in adults. While this review focuses on screening tools that can be used by nursing staff, all included screeners are within speech-language pathology scope of practice. Specific details about the included articles are available elsewhere in the Evidence Maps. See the Associated Article(s) section below for the citations.
Not stated
All six of the systematic reviews referenced in this review are included in this Evidence Map:<br />
<ul>
<li>Benfield, J. K., Everton, L. F., Bath, P. M., & England, T. J. (2020). Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta-analysis. Journal of Clinical Nursing, 29(9-10), 1527–1538. https://doi.org/10.1111/jocn.15192</li>
<li>Bours, G. J., Speyer, R., Lemmens, J., Limburg, M., & de Wit, R. (2009). Bedside screening tests vs. videofluoroscopy or fibreoptic endoscopic evaluation of swallowing to detect dysphagia in patients with neurological disorders: Systematic review. Journal of Advanced Nursing, 65(3), 477–493. https://doi.org/10.1111/j.1365-2648.2008.04915.x</li>
<li>Kertscher, B., Speyer, R., Palmieri, M., & Plant, C. (2014). Bedside screening to detect oropharyngeal dysphagia in patients with neurological disorders: An updated systematic review. Dysphagia, 29(2), 204–212. https://doi.org/10.1007/s00455-013-9490-9</li>
<li>O'Horo, J. C., Rogus-Pulia, N., Garcia-Arguello, L., Robbins, J., & Safdar, N. (2015). Bedside diagnosis of dysphagia: A systematic review. Journal of Hospital Medicine, 10(4), 256–265. https://doi.org/10.1002/jhm.2313</li>
<li>Park, K. D., Kim, T. H., & Lee, S. H. (2020). The Gugging Swallowing Screen in dysphagia screening for patients with stroke: A systematic review. International Journal of Nursing Studies, 107, 103588. https://doi.org/10.1016/j.ijnurstu.2020.103588</li>
<li>Park, Y. H., Bang, H. L., Han, H. R., & Chang, H. K. (2015). Dysphagia screening measures for use in nursing homes: A systematic review. Journal of Korean Academy of Nursing, 45(1), 1–13. https://doi.org/10.4040/jkan.2015.45.1.1</li>
</ul>
2005 to 2020
Systematic reviews of randomized controlled trials or cross-sectional studies
6
This review reported fair to good sensitivity and specificity for four bedside screening tools used by nurses to identify dysphagia in adults. Specific psychometrics were as follows:<br />
<ul>
<li>the 3 ounce water test: sensitivity = 76%–98%, specificity = 30%–76.9%, positive likelihood ratio (LR+) = 1, negative likelihood ratio (LR-) = 0.6;</li>
<li>the Gugging Swallow Screen (GUSS): sensitivity = 84%–100%, specificity = 50%–87.5%, positive predictive value = 55.5%–93.3%, negative predictive value = 55.5%–93.3%, LR+ = 2.8, LR- = undefined;</li>
<li>the Mann Assessment of Swallowing Ability (MASA): sensitivity = 58%–93%, specificity = 30%–63%, LR+ = 1.2–6.7, LR- = 0.1–0.7; and</li>
<li>the Toronto Bedside Swallowing Screening Test (TOR-BSST): sensitivity = 80%–96% ; specificity = 64%–68%, LR+ = 2.5–2.7, LR-=0.1–0.3.</li>
</ul>
Limitations to this review include a lack of comparative analysis between tests, limited usability and cost-effectiveness data, and an overrepresentation of individuals with stroke. Future research should investigate the clinical utility of a wide range of screening tools across various settings and populations.
