Abstract
Swallowing screening is critical in rapid identification of risk of aspiration in patients presenting with acute stroke symptoms. Accuracy in judgments is vital for the success of the screening. This study examined speech-language pathologists’ (SLPs) reliability in interpreting screening items. Swallowing screening was completed in 75 individuals admitted with stroke symptoms. Screening items evaluated were lethargy, dysarthria, wet voice unrelated to swallowing, abnormal volitional cough, and cough, throat clear, wet voice after swallowing, and inability to continuously drink with ingestion of 5 and 90 ml water. Two SLPs, each with more than 10 years of experience, made simultaneous independent judgments of the same observations obtained from the screening. Overall, generally high agreement was identified between the SLPs (k[SE] = 0.83[0.03]). Individual kappas ranged from 0.38 (fair) for non-swallowing wet voice to 0.95 (almost perfect) for cough after swallow, with one item omitted due to minimal variation. SLPs demonstrate high reliability in swallowing screening. Results, however, indicate some potential variability. Items associated with trial swallows had the highest reliability, whereas items related to judgments of speech and voice quality had the lowest. Although SLPs have dedicated training and ample opportunity to practice, differences in agreement are evident. Routine practice in hospital departments is recommended to establish and maintain sensitive perceptual discrimination. If other professionals are to provide swallowing screening, knowledge of SLPs’ reliability levels must be considered when identifying screening items, creating education modules, and determining acceptable levels of agreement.
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Acknowledgments
The authors would like to acknowledge the contribution of the research coordinators, Yanneth Rivera and William Wehner. Portions of this work were presented at the European Swallowing and Swallowing Disorders Annual Conference, October 23-25, 2014, Brussels, Belgium. The project described was based on work supported by a Merit Award (1I01RX000121) from the Rehabilitation Research & Development Service of the VA Office of Research and Development. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the University of Texas School of Public Health.
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Stephanie K. Daniels, Shweta Pathak, and Robert O. Morgan received salary support through a grant from the Department of Veterans Affairs. Carol B. Stach, Tiffany M. Mohr, and Jane A. Anderson report no conflict of interest.
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Daniels, S.K., Pathak, S., Stach, C.B. et al. Speech Pathology Reliability for Stroke Swallowing Screening Items. Dysphagia 30, 565–570 (2015). https://doi.org/10.1007/s00455-015-9638-x
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DOI: https://doi.org/10.1007/s00455-015-9638-x