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Screening for Dysphagia in Adult Patients with Stroke: Assessing the Accuracy of Informal Detection

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Abstract

Early identification of dysphagia by screening is recommended best practice for patients admitted to hospital with acute stroke. Screening can reduce the risk of pneumonia and promote stroke recovery, yet some institutions do not utilize a formal screening protocol. This study assessed the accuracy of informal dysphagia detection prior to implementation of a formal screening protocol. We conducted a secondary analysis of data captured between 2003 and 2008 from a sample of 250 adult stroke survivors admitted to a tertiary care centre. Using a priori criteria, patient medical records were reviewed for notation about dysphagia; if present, the date/time of notation, writer’s profession, and suggestion of dysphagia presence. To assess accuracy of notations indicating dysphagia presence, we used speech language pathology (SLP) assessments as the criterion reference. There were 221 patient medical records available for review. Patients were male (56%), averaged 68 years (SD = 15.0), with a mean Canadian Neurological Scale score of 8.1 (SD = 3.0). First notations of swallowing by SLP were excluded. Of the remaining 170 patients, 147 (87%) had first notations (104 by nurses; 40 by physicians) within a median of 24.3 h from admission. Accuracy of detecting dysphagia from informal notations was low, with a sensitivity of 36.7% [95% CI, 24.9, 50.1], but specificity was high (94.2% [95% CI, 86.5, 97.9]). Informal identification methods, although timely, are suboptimal in their accuracy to detect dysphagia and leave patients with stroke at risk for poor health outcomes. Given these findings, we encourage the use of psychometrically validated formal screening protocols to identify dysphagia.

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Funding

The original study was funded by a grant from the Canadian Stroke Network Summer Student Program. VS received support from a University of Toronto Swallowing Lab doctoral student award. RM received support from a Canada Research Chair (Tier II) in Swallowing Disorders. HF received funding from the Heart and Stroke Foundation of Ontario and the Queen Elizabeth II Scholarships in Science and Technology. MKK received support from a Career Investigator Award, Heart and Stroke Foundation of Canada, Ontario Provincial Office.

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Correspondence to Victoria Sherman.

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Dr. Rosemary Martino is the Principal Investigator who developed the TOR-BSST©, which is mentioned in this article as a comparison to notation. Dr. Martino teaches a workshop related to the TOR-BSST©, all proceeds going to a lab research account.

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Sherman, V., Flowers, H., Kapral, M.K. et al. Screening for Dysphagia in Adult Patients with Stroke: Assessing the Accuracy of Informal Detection. Dysphagia 33, 662–669 (2018). https://doi.org/10.1007/s00455-018-9885-8

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  • DOI: https://doi.org/10.1007/s00455-018-9885-8

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