Swallow Screen Associated With Airway Protection and Dysphagia After Acute Stroke.
Rachel W Mulheren, Marlís González-Fernández
PMID 30684489WHAT IT FOUND
A nurse-administered 3-oz water screen missed many swallowing problems in 48 acute stroke patients: 15 of 35 who passed still had dysphagia on fluoroscopy.
Failed screens were associated with airway protection impairment, but passing did not rule out dysphagia.
Key findings
01Of the 48 acute stroke patients studied, 15 of the 35 patients who passed the swallow screen were diagnosed with dysphagia on VFSS.
02The swallow screen had sensitivity 46% and specificity 100% for dysphagia on VFSS, with positive predictive value 100% and negative predictive value 57%.
03Failing the swallow screen was associated with partial laryngeal elevation and incomplete laryngeal vestibule closure on VFSS.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The study included 48 acute stroke patients from one hospital, so results may not apply to other settings. The sample size was small, so confidence intervals were wide. The screen used only water boluses, so it could not detect swallowing problems with pudding or solid foods. Some MBSImP components were not scored because imaging was incomplete. Participants were assessed once, so recovery over time was not measured.
Declared interests
The paper is listed as supported by NIH extramural funding. No author conflict-of-interest statement appears in the supplied text.
The easy way to misread this
Do not conclude that a passed swallow screen rules out dysphagia. The screen had low sensitivity, and several patients who passed still had dysphagia on fluoroscopy.