Assessment of swallowing and referral to speech and language therapists in acute stroke

• Published in: QJM : An International Journal of Medicine Vol. 91; no. 12; pp. 829 - 835
• Main Authors: HINDS, N. P, WILES, C. M
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-12-1998
• Subjects: Acute Disease; Aged; Biological and medical sciences; Cerebrovascular Disorders - complications; Deglutition; Deglutition Disorders - diagnosis; Deglutition Disorders - etiology; Diseases of the nervous system; Drinking; Female; Humans; Male; Medical sciences; Neurology; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Referral and Consultation; Sensitivity and Specificity; Speech-Language Pathology; Vascular diseases and vascular malformations of the nervous system; Human; Nervous system diseases; Stroke; Acute; Cardiovascular disease; Swallowing; Cerebral disorder; Vascular disease; Orthophony; Follow up study; Central nervous system disease; Complication; Clinical investigation; Combined treatment; Diagnosis; Elderly; Cerebrovascular disease
• ISSN: 1460-2725; 1460-2393; 1460-2393
• DOI: 10.1093/qjmed/91.12.829

The best clinical assessment of swallowing following acute stroke, in order to decide whether to refer a patient to a speech and language therapist (SLT), is uncertain. Independently of the managing clinical team, we prospectively investigated 115 patients (51 male) with acute stroke, mean age 75 years (range 24-94) within 72 h of admission, using a questionnaire, structured examination and timed water swallowing test. Outcome variables included referral to and intervention by a speech and language therapist (SLT), dietary modification, respiratory complications and death. Of those patients in whom an SLT recommended intervention, 97% were detected by an abnormal quantitative water swallowing test; specificity was 69%. An SLT was very unlikely to recommend any intervention if the test was normal. Inability to perform a water test and/or abnormality of the test was associated with significantly increased relative risks of death, chest infection and dietary modification. A timed water swallowing test can be a useful test of swallowing and may be used to screen patients for referral to a speech and language therapist after acute stroke.