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
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Article info
Publication history
Published online: April 23, 2016
Footnotes
Supported by a Merit Award (award no. 1I0RX00121) from the Rehabilitation Research and Development of the Veterans Affairs Office of Research and Development Service. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the University of Texas School of Public Health. The full study protocol can be accessed at the Department of Veterans Affairs.
Disclosures: S.K.D., S.P., J.C.R., and R.O.M. received salary support from the Merit Award (award no. 1I0RX00121) from the Rehabilitation Research and Development of the Veterans Affairs Office of Research and Development Service. J.A.A. has nothing to disclose.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
