EBP Compendium: Summary of Systematic Review
South Thames Research and Development Directorate of the Department of Health
Screening for Dysphagia and Aspiration in Acute Stroke: A Systematic Review
Perry, L., & Love, C. P.
Dysphagia, 16(1), 7-18.
Indicators of Review Quality:
The review addresses a clearly focused question
Criteria for inclusion of studies are provided
Search strategy is described in sufficient detail for replication
Included studies are assessed for study quality
Quality assessments are reproducible
Description: This is a review of studies investigating dyspahagia screening and aspiration in individuals with acute stroke.
"What are the incidence and outcomes of dysphagia
and aspiration in acute stroke?
What screening methods are available to detect dysphagia
in patients with acute stroke?
What effect has screening swallowing function upon
patient outcomes?" (p. 8).
Population: Adults experiencing acute stroke
Intervention/Assessment: Clinical screening methods for dysphagia (ex. Burke Dysphagia Screening Test (BDST), Standardized Swallowing Assessment (SSA), Bedside Swallowing Assessment (BSA), etc.).
Number of Studies Included: 26
Years Included: Up to September 1999
- Assessment Areas
- Swallowing - The authors found the incidence of dysphagia in acute stroke patients to vary based on screening measure and timing of screening. At the acute stage (less than 7 days), incidence of dysphgia ranged from 43%-67% based on clinical examination of ability to drink water and 65%-80% based on videofluoroscopic swallowing studies (VSS) results.
- Assessment Instruments
- General Findings
- Five clinical screening methods were identified in the literature: 1) clinical examination; 2) Burke Dysphagia Screening Test (BDST); 3) Sandardized Swallowing Assessment (SSA); 4) the timed test of Hinds and Wiles; and 5) Bedside Swallowing Assessment (BSA).
- All reported roughly similar sensitivity and specificity rates. Four screening tools used VSS as gold standard. However limited standardization as well as other factors such as radiation exposure and positioning during VSS should be considered.
- Further validation and reliability testing of dysphagia screening tools is warranted.
- Standardized Swallowing Assessment (SSA)
- Only two studies examined the use of screening tools for managnement of dysphagia (use of SSA and interdiscplinicary dysphagia protocol). The authors concluded that "both demonstrated positive outcomes in terms of identification of problems, appropriateness of referral and management, and/or reduced incidence of lower respiratory tract infection" (p. 14).
- The authors found the SSA performed better that the 3-oz water swallow test in determining relative risk of lower respitory tract infection. However, the SSA was reportedly less sensitive that then BDST.
- Additionally, the SSA was the only tool with published reliability data.
- Compared to the timed test and BSA, the SSA demonstratred the lowest percentage of unassessable patients suggesting its relative clinical utility.
- Pulse Oximetry - Use of pulse oximetry as a screening tool for identification of aspiration could not be determined.
Keywords: Stroke, Swallowing Disorders, Clinical Bedside Assessment, Instrumental Assessment
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Added to Compendium: March 2012