Rapid Aspiration Screening for Suspected Stroke: Part 1: Development and Validation

Abstract

Objective: To develop and validate a nurse-administered screening tool to identify aspiration risk in patients with suspected stroke.

Design: Validity study comparing evidence-based swallowing screening items with the videofluoroscopic swallowing study (VFSS) results.

Setting: A certified primary stroke center in a major metropolitan medical facility.

Participants: Consecutive patients (N=250) admitted with suspected stroke.

Interventions: Patients were administered evidence-based swallowing screening items by nurses. A VFSS was completed within 2 hours of swallowing screening.

Main outcome measures: Validity relative to identifying VFSS-determined aspiration for each screening item and for various combinations of items.

Results: Aspiration was identified in 29 of 250 participants (12%). Logistic regression revealed that age (P=.012), dysarthria (P=.001), abnormal volitional cough (P=.030), and signs related to the water swallow trial (P=.021) were significantly associated with aspiration. Validity was then determined on the basis of the best combination of significant items for predicting aspiration. The results revealed that age >70 years, dysarthria, or signs related to the water swallow trial (ie, cough, throat clear, wet vocal quality, and inability to continuously drink 90mL water) yielded 93% sensitivity and 98% negative predictive value.

Conclusions: The final validated tool, Rapid Aspiration Screening for Suspected Stroke, is a valid nurse-administered tool to detect risk of aspiration in patients presenting with suspected stroke.

Keywords: Deglutition; Deglutition disorders; Rehabilitation; Stroke.