Advertisement

Rapid Aspiration Screening for Suspected Stroke

Part 1: Development and Validation
Published:April 23, 2016DOI:https://doi.org/10.1016/j.apmr.2016.03.025

      Abstract

      Objective

      To develop and validate a nurse-administered screening tool to identify aspiration risk in patients with suspected stroke.

      Design

      Validity study comparing evidence-based swallowing screening items with the videofluoroscopic swallowing study (VFSS) results.

      Setting

      A certified primary stroke center in a major metropolitan medical facility.

      Participants

      Consecutive patients (N=250) admitted with suspected stroke.

      Interventions

      Patients were administered evidence-based swallowing screening items by nurses. A VFSS was completed within 2 hours of swallowing screening.

      Main Outcome Measures

      Validity relative to identifying VFSS-determined aspiration for each screening item and for various combinations of items.

      Results

      Aspiration was identified in 29 of 250 participants (12%). Logistic regression revealed that age (P=.012), dysarthria (P=.001), abnormal volitional cough (P=.030), and signs related to the water swallow trial (P=.021) were significantly associated with aspiration. Validity was then determined on the basis of the best combination of significant items for predicting aspiration. The results revealed that age >70 years, dysarthria, or signs related to the water swallow trial (ie, cough, throat clear, wet vocal quality, and inability to continuously drink 90mL water) yielded 93% sensitivity and 98% negative predictive value.

      Conclusions

      The final validated tool, Rapid Aspiration Screening for Suspected Stroke, is a valid nurse-administered tool to detect risk of aspiration in patients presenting with suspected stroke.

      Keywords

      List of abbreviations:

      ED (emergency department), NIHSS (National Institutes of Health Stroke Scale), NPV (negative predictive value), PPV (positive predictive value), RN (registered nurse), ROC (receiver operating characteristic), SLP (speech-language pathologist), SST (swallowing screening tool), TIA (transient ischemic attack), VFSS (videofluoroscopic swallowing study)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Hinchey J.A.
        • Shephard T.
        • Furie K.
        • Smith D.
        • Wang D.
        • Tonn S.
        Formal dysphagia screening protocols prevent pneumonia.
        Stroke. 2005; 36: 1972-1976
        • Martino R.
        • Pron G.
        • Diamant N.
        Screening for oropharyngeal dysphagia in stroke: insufficient evidence for guidelines.
        Dysphagia. 2000; 15: 19-30
        • Odderson I.R.
        • McKenzie B.S.
        A model for management of patients with stroke during the acute phase: outcome and economic implications.
        Stroke. 1993; 24: 1823-1827
        • Jauch E.C.
        • Saver J.L.
        • Adams H.P.
        • et al.
        Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2013; 44: 870-947
        • Edmiaston J.
        • Connor L.T.
        • Steger-May K.
        • Ford A.L.
        A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity.
        J Stroke Cerebrovasc Dis. 2014; 23: 712-716
        • Martino R.
        • Silver F.
        • Teasell R.
        • et al.
        The Toronto Bedside Swallowing Screening Test (TOR-BSST): development and validation of a dysphagia screening tool for patients with stroke.
        Stroke. 2009; 40: 555-561
        • Suiter D.B.
        • Leder S.B.
        Clinical utility of the 3 ounce water swallow test.
        Dysphagia. 2008; 23: 244-250
        • Trapl M.
        • Enderle P.
        • Nowotny M.
        • et al.
        Dysphagia bedside screening for acute-stroke patients: the Gugging Swallowing Screen.
        Stroke. 2007; 38: 2948-2952
        • Daniels S.K.
        • Brailey K.
        • Priestly D.H.
        • et al.
        Aspiration in patients with acute stroke.
        Arch Phys Med Rehabil. 1998; 79: 14-19
        • Daniels S.K.
        • Anderson J.A.
        • Petersen N.J.
        Implementation of stroke dysphagia screening in the emergency department.
        Nurs Res Pract. 2013; 2013: 304190
        • Anderson J.A.
        • Pathak S.
        • Rosenbek J.C.
        • Morgan R.O.
        • Daniels S.K.
        Rapid Aspiration Screening for Suspected Stroke: part 2: initial and sustained nurse accuracy and reliability.
        Arch Phys Med Rehabil. 2016; 97: 1449-1455
        • Mann G.
        • Hankey G.J.
        • Cameron D.
        Swallowing function after stroke: prognosis and prognostic factors at 6 months.
        Stroke. 1999; 30: 744-748
        • Smithard D.G.
        • O'Neill P.A.
        • Parks C.
        • Morris J.
        Complications and outcome after acute stroke. Does dysphagia matter?.
        Stroke. 1996; 27: 1200-1204
        • Daniels S.K.
        • Anderson J.A.
        • Willson P.C.
        Valid items for screening dysphagia risk in patients with stroke: a systematic review.
        Stroke. 2012; 43: 892-897
        • Polit D.F.
        • Beck C.T.
        Nursing research: generating and assessing evidence for nursing practice.
        8th ed. Wolters Kluwer, New York2008
        • Streiner D.L.
        Diagnosing tests: using and misusing diagnostic and screening tests.
        J Pers Assess. 2003; 81: 209-219
        • Lakshminarayan K.
        • Tsai A.W.
        • Tong X.
        • et al.
        Utility of dysphagia screening results in predicting poststroke pneumonia.
        Stroke. 2010; 41: 2849-2854
        • Masrur S.
        • Smith E.E.
        • Saver J.L.
        • et al.
        Dysphagia screening and hospital-acquired pneumonia in patients with acute ischemic stroke: findings from Get with the Guidelines-Stroke.
        J Stroke Cerebrovasc Dis. 2013; 22: e301-e309
        • Reeves M.
        • Khoury J.
        • Alwell K.
        • et al.
        Distribution of National Institutes of Health Stroke Scale in the Cincinnati/Northern Kentucky Stroke Study.
        Stroke. 2013; 44: 3211-3213
        • Nicosa M.A.
        • Hind J.A.
        • Roecker E.B.
        • et al.
        Age effects on the temporal evolution of isometric and swallowing pressures.
        J Gerontol A Biol Sci Med Sci. 2000; 55: M634-M640
        • Chumbler N.R.
        • Williams L.S.
        • Wells C.K.
        • Lo A.C.
        • Nadeau S.
        • Peixoto A.J.
        Derivation and validation of a clinical system for predicting pneumonia in acute stroke.
        Neuroepidemiology. 2010; 34: 193-199
        • McCullough G.H.
        • Rosenbek J.C.
        • Wertz R.T.
        • McCoy S.
        • Mann G.
        • McCullough K.
        Utility of clinical swallowing examination measures for detecting aspiration post-stroke.
        J Speech Lang Hear Res. 2005; 48: 1280-1293
        • Parker C.
        • Power M.
        • Hamdy S.
        • Bowen A.
        • Tyrrell P.
        • Thompson D.G.
        Awareness of dysphagia by patients following stroke predicts swallowing performance.
        Dysphagia. 2004; 19: 28-35
        • Schroeder M.F.
        • Daniels S.K.
        • McClain M.
        • Corey D.M.
        • Foundas A.L.
        Clinical and cognitive predictors of swallowing recovery in stroke.
        J Rehabil Res Develop. 2006; 43: 301-310