Summary of the Systematic Review

Article Citation

Screening for Dysphagia and Aspiration in Acute Stroke: A Systematic Review

Perry, L., & Love, C. P. (2001).
Dysphagia, 16(1), 7-18.
Go to Article

Sponsoring Body

South Thames Research and Development Directorate of the Department of Health (United Kingdom)

Article Quality Ratings

Read about Our Rating Process

Indicators of Review Quality

  • Yes The review states a clearly focused question/aim.
  • Yes Criteria for inclusion of studies are provided.
  • No Search strategy described in sufficient detail for replication.
  • Yes Included studies are assessed for study quality.
  • No Quality assessments are reproducible.
  • Yes Characteristics of the included studies are provided.

Article Details

Description

This is a review of studies investigating dysphagia screening and aspiration in individuals with acute stroke. 

Questions/Aims Addressed

  1. What are the incidence and outcomes of dysphagia and aspiration in acute stroke?
  2. What screening methods are available to detect dysphagia in patients with acute stroke?
  3. What effect has screening swallowing function upon patient outcomes?

Population

Adults experiencing acute stroke

Intervention/Assessment

Clinical screening methods for dysphagia such as: 
  • The Burke Dysphagia Screening Test, 
  • Standardized Swallowing Assessment, and  
  • bedside swallowing assessments. 

Number of Studies Included

26

Years Included

Up to September 1999


Conclusions from This Systematic Review

What are Conclusions?

Go to Map

Screening

Use of pulse oximetry as a screening tool for identification of aspiration could not be determined.

Keywords: Dysphagia, Pulse Oximetry, Stroke

The following clinical screening methods were identified in the literature and reported roughly the same sensitivity and specificity rates for identifying dysphagia and aspiration risk for individuals diagnosed with stroke:

  • clinical examination (presentation of any two clinical signs of swallowing problems);
  • water swallow tests (e.g., Burke Dysphagia Screening Test);
  • Standardized Swallowing Assessment;
  • the timed test of Hinds and Wiles; and
  • Bedside Swallowing Assessment.

Four screening tools used [videofluoroscopic swallow study (VSS)] as the 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.

Keywords: Assessment of Clinical Features (e.g. Gag Reflex), Protocols (e.g. MASA), Dysphagia, Water Swallow Tests, Stroke

Assessment

Use of pulse oximetry as a screening tool for identification of aspiration could not be determined.

Keywords: Dysphagia, Pulse Oximetry, Stroke

Compared to the Hinds and Wiles Timed Test and the Bedside Swallowing Assessment, [the Standardized Swallowing Assessment (SSA)] demonstrated the lowest percentage of unassessable patients suggesting its relative clinical utility in screening patients for suspected dysphagia. Additionally, the SSA was the only tool with published reliability data.

Keywords: Dysphagia, Protocols (e.g. MASA), Stroke

Only two studies examined the use of protocols for the screening and management of dysphagia post stroke. Tests included the Standardized Swallowing Assessment and the 50 ml3 drinking test. The authors concluded that "both demonstrated positive outcomes in terms of identification of [swallowing] problems, appropriateness of referral and management, and/or reduced incidence of lower respiratory tract infection" (p. 14).

Keywords: Dysphagia, Protocols (e.g. MASA), Stroke

[The Standardized Swallowing Assessment (SSA)] performed better than the 3-oz water swallow test in determining relative risk of lower respiratory tract infection. However, the SSA was reportedly less sensitive than the Burke Dysphagia Screening Test, a 50ml water swallow test.

Keywords: Dysphagia, Protocols (e.g. MASA), Water Swallow Tests, Stroke

The following clinical screening methods were identified in the literature and reported roughly the same sensitivity and specificity rates for identifying dysphagia and aspiration risk for individuals diagnosed with stroke:

  • clinical examination (presentation of any two clinical signs of swallowing problems);
  • water swallow tests (e.g., Burke Dysphagia Screening Test);
  • Standardized Swallowing Assessment;
  • the timed test of Hinds and Wiles; and
  • Bedside Swallowing Assessment.

Four screening tools used [videofluoroscopic swallow study (VSS)] as the 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.

Keywords: Assessment of Clinical Features (e.g. Gag Reflex), Protocols (e.g. MASA), Dysphagia, Water Swallow Tests, Stroke

Go to Map

Screening

Use of pulse oximetry as a screening tool for identification of aspiration could not be determined.

Keywords: Dysphagia, Pulse Oximetry, Stroke

Compared to the Hinds and Wiles Timed Test and the Bedside Swallowing Assessment, [the Standardized Swallowing Assessment (SSA)] demonstrated the lowest percentage of unassessable patients suggesting its relative clinical utility in screening patients for suspected dysphagia. Additionally, the SSA was the only tool with published reliability data.

Keywords: Dysphagia, Protocols (e.g. MASA), Stroke

Only two studies examined the use of protocols for the screening and management of dysphagia post stroke. Tests included the Standardized Swallowing Assessment and the 50 ml3 drinking test. The authors concluded that "both demonstrated positive outcomes in terms of identification of [swallowing] problems, appropriateness of referral and management, and/or reduced incidence of lower respiratory tract infection" (p. 14).

Keywords: Dysphagia, Protocols (e.g. MASA), Stroke

[The Standardized Swallowing Assessment (SSA)] performed better than the 3-oz water swallow test in determining relative risk of lower respiratory tract infection. However, the SSA was reportedly less sensitive than the Burke Dysphagia Screening Test, a 50ml water swallow test.

Keywords: Dysphagia, Protocols (e.g. MASA), Water Swallow Tests, Stroke

The following clinical screening methods were identified in the literature and reported roughly the same sensitivity and specificity rates for identifying dysphagia and aspiration risk for individuals diagnosed with stroke:

  • clinical examination (presentation of any two clinical signs of swallowing problems);
  • water swallow tests (e.g., Burke Dysphagia Screening Test);
  • Standardized Swallowing Assessment;
  • the timed test of Hinds and Wiles; and
  • Bedside Swallowing Assessment.

Four screening tools used [videofluoroscopic swallow study (VSS)] as the 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.

Keywords: Assessment of Clinical Features (e.g. Gag Reflex), Protocols (e.g. MASA), Dysphagia, Water Swallow Tests, Stroke

Our Partners