Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke

HomeStrokeVol. 53, No. 9Screening for Aspiration Risk Associated With Dysphagia in Acute Stroke Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBScreening for Aspiration Risk Associated With Dysphagia in Acute Stroke Elizabeth Boaden, Jane Burnell, Lucy Hives, Paola Dey, Andrew Clegg, Mary W. Lyons, C. Elizabeth Lightbody, Margaret A. Hurley, Hazel Roddam, Elizabeth McInnes, Anne W. Alexandrov and Caroline L. Watkins Elizabeth BoadenElizabeth Boaden Correspondence to: Elizabeth Boaden, PhD, Senior Research Fellow, Stroke Research Team, Brook Building 247, University of Central Lancashire, Preston, PR1 2HE. Email E-mail Address: [email protected] https://orcid.org/0000-0002-4647-6392 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. , Jane BurnellJane Burnell https://orcid.org/0000-0002-4601-1632 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. , Lucy HivesLucy Hives https://orcid.org/0000-0003-4125-4034 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. , Paola DeyPaola Dey https://orcid.org/0000-0003-4555-1917 Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom (P.D.). , Andrew CleggAndrew Clegg https://orcid.org/0000-0001-8938-7819 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. , Mary W. LyonsMary W. Lyons https://orcid.org/0000-0001-7532-2301 Liverpool School of Tropical Medicine, United Kingdom (M.W.L.). , C. Elizabeth LightbodyC. Elizabeth Lightbody https://orcid.org/0000-0001-5016-3471 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Lancashire Teaching Hospitals NHS Foundation Trust, United Kingdom (C.E.L.). , Margaret A. HurleyMargaret A. Hurley https://orcid.org/0000-0002-2502-432X Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. , Hazel RoddamHazel Roddam https://orcid.org/0000-0002-0637-1801 Faculty of Allied Health and Well-being (H.R.), University of Central Lancashire, Preston, United Kingdom. , Elizabeth McInnesElizabeth McInnes https://orcid.org/0000-0002-0567-9679 Nursing Research Institute, Australian Catholic University, Sydney, Australia (E.M.). , Anne W. AlexandrovAnne W. Alexandrov https://orcid.org/0000-0002-4060-6766 Department of Acute and Tertiary Care, University of Tennessee Health Science Center (UTHSC), Memphis (A.W.A.). and Caroline L. WatkinsCaroline L. Watkins https://orcid.org/0000-0002-9403-3772 Faculty of Health and Care (E.B., J.B., L.H., A.C., C.E.L., M.A.H., C.L.W.), University of Central Lancashire, Preston, United Kingdom. Originally published22 Aug 2022https://doi.org/10.1161/STROKEAHA.122.037998Stroke. 2022;53:e424–e425Swallowing difficulties (dysphagia) are common following stroke. People with dysphagia are more likely to aspirate and develop pneumonia, causing further morbidity, increased hospital stay, and risk of death.ObjectiveTo identify the diagnostic accuracy of swallow screening tests to accurately identify aspiration associated with dysphagia, subsequent to acute stroke.MethodsWe searched relevant electronic databases from inception to December 2019: CENTRAL, MEDLINE, Embase, CINAHL, and Health Technology Assessment. We hand searched the reference lists of all included studies and performed a cited reference search using Science Citation Index. We contacted experts in the field to identify ongoing studies and searched targeted gray literature from Cochrane recommended database: the Canadian Agency for Drugs and Technologies in Health.We considered cohort and case-control studies comparing the accuracy of a swallow screening test with identified reference tests (videofluoroscopy, fiberoptic endoscopic evaluation of swallowing, scintigraphy, expert assessment).Two review authors independently selected studies, extracted data, and assessed risk of bias and methodological quality using the QUADAS-2 tool, with a third author moderating disagreements.ResultsThe searches identified 26 703 studies. After removing duplicates, 20 567 studies were screened, and 233 proceeded to full-text review. Thirty-seven screening tests were investigated in the 25 included studies and 4 narratives (no accuracy statistics reported). These tests were categorized: 24 (65%) tests used water only, 6 (16%) used a combination of water and other consistencies, for example, semisolids and solids, and 7 (19%) used other methods.The best performing tests in each category with a low risk of bias across all 4 QUADAS-2 domains were the Toronto Bedside Swallowing Screening Test (water only) with a sensitivity of 1.00 (95% CI, 0.75–1.00) and specificity of 0.64 (95% CI, 0.31–0.89); the Gugging Swallowing Screen (water, semisolids, and solid trials and management plan) with a sensitivity of 1.00 (95% CI, 0.77–1.00) and specificity of 0.69 (95% CI, 0.41–0.89); and the Bedside Aspiration test (combined water swallow test and instrumental assessment) with a sensitivity of 1.00 (95% CI, 0.87–1.00) and specificity of 0.71 (95% CI, 0.49–0.87).Screening tools that used a combination of water and other consistencies as testing materials (accuracy ranged from sensitivity of 0.75 [95% CI, 0.35–0.97] and specificity of 0.89 [95% CI, 0.75–0.97], to sensitivity of 1.00 [95% CI, 0.69–1.00] and specificity of 0.86 [95% CI, 0.65–0.97]) were more accurate than screening tests that used only water (accuracy ranged from sensitivity of 0.46 [95% CI, 0.28–0.66] and specificity of 1.00 [95% CI, 0.83–1.00] to sensitivity of 1.00 [95% CI, 0.75–1.00] and specificity of 0.64 [95% CI, 0.31–0.89]).Implications for PracticeThis review1 guides policymakers and healthcare workers to select the most appropriate swallow screening test for their setting. Clinicians should consider these results with caution as the recommended screening tools had small sample sizes (n<100), which limits interpretation of the estimates of reliability.Implications for ResearchHigh-quality, appropriately statistically powered studies with clearly defined outcomes are needed to provide robust evidence for individual screening tests. Reporting swallow screening test quality and cost-effectiveness data would build up a more robust body of evidence.Article InformationSources of FundingProfessors Watkins and Clegg are part funded by the National Institute for Health Research Applied Research Collaboration North West Coast (NIHR ARC NWC). The views expressed are those of the authors and not necessarily those of the NIHR or Department of Health and Social Care.AcknowledgmentsThis article is based on a Cochrane Review published in The Cochrane Library 2021, Issue 10 (see www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.Disclosures None.FootnotesFor Sources of Funding and Disclosures, see page e425.Correspondence to: Elizabeth Boaden, PhD, Senior Research Fellow, Stroke Research Team, Brook Building 247, University of Central Lancashire, Preston, PR1 2HE. Email eboaden1@uclan.ac.ukReferences1. Boaden E, Burnell J, Hives L, Dey P, Clegg A, Lyons MW, Lightbody CE, Hurley MA, Roddam H, McInnes E, et al. Screening for aspiration risk associated with dysphagia in acute stroke.Cochrane Database of Syst Rev. 2021; 10:CD012679. doi: 10.1002/14651858.CD012679Google Scholar eLetters(0)eLetters should relate to an article recently published in the journal and are not a forum for providing unpublished data. Comments are reviewed for appropriate use of tone and language. Comments are not peer-reviewed. Acceptable comments are posted to the journal website only. Comments are not published in an issue and are not indexed in PubMed. Comments should be no longer than 500 words and will only be posted online. References are limited to 10. Authors of the article cited in the comment will be invited to reply, as appropriate.Comments and feedback on AHA/ASA Scientific Statements and Guidelines should be directed to the AHA/ASA Manuscript Oversight Committee via its Correspondence page.Sign In to Submit a Response to This Article Previous Back to top Next FiguresReferencesRelatedDetails September 2022Vol 53, Issue 9 Advertisement Article InformationMetrics © 2022 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.122.037998 Originally publishedAugust 22, 2022 Keywordsmass screeningaspirationdeglutition disordersstrokePDF download Advertisement SubjectsCerebrovascular Disease/Stroke