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. 2023 Dec 12:9:23779608231219183.
doi: 10.1177/23779608231219183. eCollection 2023 Jan-Dec.

Aspiration Risk Screening With Tongue Pressure Measurement in Acute Stroke: A Diagnostic Accuracy Study Using STARD Guidelines

Pál Tamás Szabó  1   2 , Viktória Műhelyi  2 , Tímea Halász  3 , Katalin Anna Béres-Molnár  2 , András Folyovich  2   4 , Zoltán Balogh  1   5
Affiliations

Aspiration Risk Screening With Tongue Pressure Measurement in Acute Stroke: A Diagnostic Accuracy Study Using STARD Guidelines

Pál Tamás Szabó et al. SAGE Open Nurs. .

Abstract

Introduction: Dysphagia can affect more than 50% of stroke patients in the acute phase. Aspiration pneumonia is a serious complication that can be prevented with dysphagia screening and assessment. Measurement of tongue elevation pressure is suggested to be a useful tool in aspiration risk screening.

Objective: This study aimed to assess the diagnostic accuracy of maximum anterior tongue elevation strength (Pmax) in acute stroke care.

Method: In this prospective study, data were collected in a neurology department (stroke center) where patients formed a consecutive case series. The sample consisted of thirty stroke patients who failed an initial dysphagia screening. Patients underwent anterior tongue elevation strength measurement (index test) during bedside dysphagia assessment by a speech-language pathologist and flexible endoscopic evaluation of swallowing (reference test) by an otorhinolaryngologist on the same day. Outcome variables (index values in kPa, reference values interpreted on the penetration-aspiration scale) were used for estimating measures of diagnostic accuracy in aspiration risk screening.

Results: Ten patients aspirated on instrumental evaluation. At the cut-off point of ≤ 34 kPa the analysis showed 90% sensitivity, 35% specificity, 41% positive predictive value, and 88% negative predictive value. The area under the curve (AUC) for Pmax was AUC = 0.700 (95% CI [0.500-0.900]).

Conclusion: Although individuals with low anterior tongue elevation strength tend to have a higher risk of aspiration, this variable alone is not capable of screening aspiration in acute stroke. In combination with a thorough noninstrumental bedside examination, it might have the potential to reduce the number of false positive cases. Further studies in this area would be worthwhile.

Keywords: acute stroke; bedside assessment; dysphagia screening; swallowing diagnostics; tongue pressure.

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Conflict of interest statement

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow of participants in the study according to the STARD guidelines. STARD = Standards for the Reporting of Diagnostic Accuracy Studies; CBA = clinical bedside assessment.
Figure 2.
Figure 2.
Receiver operating characteristic curve (ROC) for prediction of aspiration risk by Pmax.
See this image and copyright information in PMC

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