Early assessments of dysphagia and aspiration risk in acute stroke patients.

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

Stroke

journal_title

Stroke

authors

Ramsey DJ,Smithard DG,Kalra L

doi

10.1161/01.STR.0000066309.06490.B8

subject

Has Abstract

pub_date

2003-05-01 00:00:00

pages

1252-7

issue

5

eissn

0039-2499

issn

1524-4628

pii

01.STR.0000066309.06490.B8

journal_volume

34

pub_type

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