Original research| Volume 97, ISSUE 9, P1440-1448, September 2016

Rapid Aspiration Screening for Suspected Stroke

Part 1: Development and Validation
Published:April 23, 2016DOI:



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


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


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


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


      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.


      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.


      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.


      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)
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