Abstract:
BACKGROUND AND PURPOSE:Dysphagia is common after stroke and is a marker of poor prognosis. Early identification is important. This article reviews the merits and limitations of various assessment methods available to clinicians. METHODS:An electronic database search was performed of MEDLINE, EMBASE, and the Cochrane database using such terms as stroke, aspiration, dysphagia, and assessment; extensive manual searching of articles was also conducted. RESULTS:Bedside tests are safe, relatively straightforward, and easily repeated but have variable sensitivity (42% to 92%), specificity (59% to 91%), and interrater reliability (kappa=0 to 1.0). They are also poor at detecting silent aspiration. Videofluoroscopy gives anatomic and functional information and allows testing of therapeutic techniques. However, swallowing is assessed under ideal conditions that are different from clinical settings, and reliability is often poor (kappa=0 to 0.75) in the absence of assessor training. Fiberoptic endoscopy allows swallow assessment and sensory testing but requires specialized staff and equipment. Oxygen desaturation during swallowing may be predictive of aspiration (sensitivity, 73% to 87%; specificity, 39% to 87%) but is more useful in combination with bedside testing than in isolation. Other methods of swallow testing are invasive and require specialized staff and equipment. CONCLUSIONS:Although bedside tests remain an important early screening tool for dysphagia and aspiration risk, further refinements are needed to improve their accuracy.
journal_name
Strokejournal_title
Strokeauthors
Ramsey DJ,Smithard DG,Kalra Ldoi
10.1161/01.STR.0000066309.06490.B8subject
Has Abstractpub_date
2003-05-01 00:00:00pages
1252-7issue
5eissn
0039-2499issn
1524-4628pii
01.STR.0000066309.06490.B8journal_volume
34pub_type
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