Learning Objective 1: 1. Identify valid evidence-based dysphagia screening items for use with patients experiencing neurological difficulties such as stroke.
Learning Objective 2: 2. Discuss swallowing protocols and item sensitivity and specificity as they relate to assessment of patients with stroke.
Early detection of dysphagia in acute stroke is critical as it allows for immediate intervention, thereby reducing mortality, morbidity, length of hospitalization, and healthcare costs. These findings have led to the recommendation to screen swallowing ability in all acute stroke patients, regardless of stroke severity. A systematic review of the literature was undertaken to determine the evidence-based validity of dysphagia screening items using instrumental evaluation as the reference standard.
Four databases from 1985 through March, 2011 were searched using the terms cerebrovascular disease, stroke deglutition disorders, and dysphagia. Eligibility criteria were: homogeneous stroke population, comparison to instrumental examination, clinical examination without equipment, outcome measures of dysphagia and aspiration, and validity for screening items reported or able to be calculated. Articles meeting inclusion criteria were evaluated for methodological rigor. Sensitivity, specificity, and predictive capabilities were calculated for each item.
Total source documents numbered 832; 86 were reviewed in full, and 16 met inclusion criteria. Study quality was variable. Testing swallowing, generally with water, was most common. Swallowing protocols, nor sensitivity and specificity were consistent across studies. Non-swallowing behaviors were also identified as predictive of aspiration.
Numerous behaviors were identified that were associated with aspiration. The best combination of non-swallowing and swallowing items as well as the best swallowing protocol remains unclear. Findings of this review will assist in development of valid clinical screening instruments that can be used by nurses to identify dysphagia among stroke patients.