Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta‐analysis

Abstract

Introduction:Nurses and other nonspecialists in dysphagia are often trained to screen swallowing poststroke. There are many basic tools that test water only, they are usually conservative, and patients that fail the test remain nil by mouth until a speech and language therapy assessment. More comprehensive tests also allow nonspecialists to recommend modified oral intake. Little is known about the accuracy, clinical utility and cost-effectiveness of these tests.Methods: Following PRISMA guidelines, a systematic review was conducted to describe comprehensive swallowing tests that are available for use in acute stroke by nurses or other nonspecialists in dysphagia. A meta-analysis was performed to evaluate accuracy and the clinical utility of the tests was considered. Searches and analyses, conducted by two reviewers, included MEDLINE, Embase, trial registries and grey literature up to December 2018. Validated studies were assessed for quality and risk of bias using QUADAS-2.Results: Twenty studies were included, describing five different tests, three of which had undergone validation. The tests varied in content, recommendations and use.There was no test superior in accuracy and clinical utility. Three studies validating the Gugging Swallow Screen provided sufficient data for meta-analysis, demonstrating high sensitivity; 96% (95% CI 0.90-0.99), but low specificity, 65% (95% CI 0.47-0.79), in line with many water swallow tests. Results should be interpreted with caution as study quality and applicability to the acute stroke population was poor. Conclusions:There is no comprehensive nurse dysphagia assessment tool that has robustly demonstrated good accuracy, clinical utility and cost-effectiveness in acute stroke. Relevance to ClinicalPractice: Nurses and other clinicians can develop competencies in screening swallowing and assessing for safe oral intake in those with poststroke S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. How to cite this article: Benfield JK, Everton LF, Bath PM, England TJ. Accuracy and clinical utility of comprehensive dysphagia screening assessments in acute stroke: A systematic review and meta-analysis. J Clin Nurs.

Ischemic Lesion Location Based on the ASPECT Score for Risk Assessment of Neurogenic Dysphagia

“…The frequency of dysphagia was not different between left-and right-sided MCA infarctions (40 out of 72 patients vs. 22 out of 41 patients; p = 0.500). Moreover, no difference in ASPECT sum scores was observed between strokes affecting the left or the right hemisphere (median 7 [IQR 5-9] vs. 7 [6][7][8][9]; p = 0.579). In the left hemisphere the strongest associations between the ASPECTS segments and dysphagia were found for the lentiform nucleus (LN) (OR 0.113 [CI 0.028-0.433; p = 0.001), the insula (In) (0.275 [0.102-0.742]; p = 0.011), and the frontal operculum (M1) (0.280 [0.094-0.834]; p = 0.022; see Table 2 and heat map [ Fig.…”

“…Although many different swallowing screening tests, which have been validated in the stroke population, provide acceptable sensitivity, no single test has been accepted as the gold standard yet [4][5][6][7][8][9]. Hence, there is an urgent need to establish additional clinical parameters, e.g., radiological findings, to raise diagnostic accuracy in identifying dysphagic patients.…”

Post-stroke Dysphagia: Recent Insights and Unanswered Questions

“…As with any screen, those for dysphagia consist of observing a patient perform a simple task to identify those who would benefit from further evaluation. Screening tests inherently have high specificity, but many suffer from low sensitivity [ 48 •, 49 ]. Although the aforementioned guidelines mention the utility of dysphagia, they do not specify types of dysphagia screens or optimal times when dysphagia should be evaluated.…”

The Contribution of Dysphagia to Acute Stroke Morbidity and Mortality in Nigeria: A Prospective Study

“…[6] Fortunately, there is emerging evidence that early detection of dysphagia reduces not only pulmonary complications but also the duration of hospital stay and overall healthcare cost for acute stroke patients. [7,8] Patients' awareness of their disabilities, including dysphagia after stroke, represents an important aspect of functional recovery. Patients with poor awareness experienced more complications of dysphagia.…”