Abstract
Objective
The goal was to examine the outcomes of an existing swallow screen protocol in comparison
to results from a formal videofluoroscopic protocol.
Design
Prospective cohort study.
Setting
Acute hospital.
Participants
Patients after acute stroke (N=48).
Interventions
Not applicable.
Main Outcome Measures
The Johns Hopkins Hospital Brain Rescue Unit 3 oz Swallow Screen was implemented by
nursing staff upon admission. Videofluoroscopy was conducted within 72 hours of diagnostic
neuroimaging and initial swallow screen. Predictive values of the bedside swallow
screen (pass/fail) for clinical judgment of dysphagia on videofluoroscopy (presence/absence)
were calculated. Overall impairment scores from the Modified Barium Swallowing Impairment
Profile were analyzed with respect to swallow screen results.
Results
Thirteen participants failed the swallow screen, and 35 passed. Of the 35 patients
who passed the swallow screen, 15 were clinically diagnosed with dysphagia on videofluoroscopy.
Although pass/fail of the swallow screen was not a significant predictor of presence/absence
of dysphagia, a logistic regression model including components of Laryngeal Elevation,
Laryngeal Vestibule Closure, and Anterior Hyoid Excursion, and sex was statistically
significant for swallow screen outcome.
Conclusion
The results of this study suggest that a swallow screen of aspiration risk can identify
patients with the most need for videofluoroscopic evaluation and dysphagia management.
Additionally, patients who fail a swallow screen are more likely to present with physiologic
impairments related to airway protection on videofluoroscopy.
Keywords
List of abbreviations:
MBSImP (Modified Barium Swallowing Impairment Profile), 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: January 23, 2019
Footnotes
Supported by the National Institutes of Health through the National Institute on Deafness and other Communication Disorders (grant no. K23 DC 011056) and the National Institute of Child Health & Human Development—National Center for Medical Rehabilitation Research (grant no. 5T32HD007414-23). The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health.
Current affiliation for Mulheren: Case Western Reserve University, Cleveland, OH.
Identification
Copyright
© 2019 by the American Congress of Rehabilitation Medicine
