Rapid Aspiration Screening for Suspected Stroke: Part 1: Development and Validation

• Published in: Archives of physical medicine and rehabilitation Vol. 97; no. 9; pp. 1440 - 1448
• Main Authors: Daniels, Stephanie K, Pathak, Shweta, Rosenbek, John C, Morgan, Robert O, Anderson, Jane A
• Format: Journal Article
• Language: English
• Published: United States 01-09-2016
• Subjects: Age Factors; Aged; Cough; Deglutition Disorders - complications; Deglutition Disorders - diagnosis; Deglutition Disorders - nursing; Dysarthria - complications; Dysarthria - diagnosis; Female; Fluoroscopy; Humans; Logistic Models; Male; Middle Aged; Reproducibility of Results; Respiratory Aspiration - complications; Respiratory Aspiration - diagnosis; Respiratory Aspiration - nursing; Stroke - complications; Stroke - diagnosis; Stroke - nursing; Deglutition; Stroke; Rehabilitation; Deglutition disorders
• ISSN: 0003-9993; 1532-821X
• DOI: 10.1016/j.apmr.2016.03.025

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.
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.