Combined approach in bedside assessment of aspiration risk post stroke: PASS

Abstract

Background: Swallowing disorders are common and serious problems post stroke. Physical signs and ingestion test consist of main approaches of bedside screening of aspiration.

Aim: To assess the composability of these approaches.

Design: A pilot study to develop a combined schema; secondly a validation study of this schema.

Setting: Inpatient of Neurology Department and of Rehabilitation Department.

Population: Forty-one patients post acute stroke included in the pilot study; 107 patients of subacute stroke for validation study.

Methods: In pilot study, patients were assessed using Clinical Predicative Scale of Aspiration (CPSA) and 3-ounce Water swallow Test (3oz WT). Videofluoroscopic examination (VFSE) was performed as gold standard when the results of screening were discordant. In validation study, swallowing disorders were assessed systematically using CPSA, 3 oz WT and VFSE.

Results: The combined screening schema, Practical Aspiration Screening Scheme (PASS), consisted of a 3oz WT to enhance results of the uncertain range of CPSA. Validation study showed that sensitivity and specificity of the 3oz WT were 87.3% and 42.3% respectively; those of CPSA were 50.1% and 50.0%, with a range of uncertainty in 42.6% of patients. The sensitivity of PASS was 89.1%, comparable to that of the 3oz WT, while the specificity of PASS was 80.8%, significantly higher than that of single tests. PASS also reduced systematic recourse to VFSE with a substantial agreement with it (kappa=0.7).

Conclusion: Physical signs and ingestion test are complementary in the screening of aspiration.

Clinical rehabilitation impact: Combined schema enhances the efficiency of bedside screening of aspiration.