Identification of a simple screening tool for dysphagia in patients with stroke using factor analysis of multiple dysphagia variables.
OBJECTIVE
To identify a most useful and simple clinical screening tool to predict videofluoroscopic aspiration in patients with stroke.


METHODS
Factor analysis of multiple dysphagia variables and sensitivity and specificity testing with chi-square test.


METHODS
Sixty-one consecutive stroke patients with symptoms suggestive of dysphagia admitted to a university hospital and its 4 affiliated hospitals in Japan.


METHODS
Factors were extracted from 6 oromotor examinations (lip closure, tongue movement, palatal elevation, gag reflex, voice quality and motor speech function), 2 swallow screen tests (saliva swallowing test and our modified water swallowing test using 30 ml of water) and 4 parameters evaluated with a videofluoroscopic swallow study. Sensitivity and specificity of each dysphagia-related variable was determined against aspiration in a videofluoroscopic swallow study.


RESULTS
Factor analysis revealed that cough/voice change in the water swallowing test and aspiration on videofluoroscopic swallow study belonged to the same factor. Chi-square analysis showed that cough/voice change in the water swallowing test was the only variable that was significantly associated with aspiration on videofluoroscopic swallow study, with a sensitivity of 72% (95% CI: 61-83%) and a specificity of 67% (CI: 55-79%) as a predictor of aspiration (p<0.05).


CONCLUSIONS
We recommend our modified 30 ml water-swallowing test as a useful single task-screening tool to detect aspiration.
Nishiwaki
Kaori
K
Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan. kaori@reha.med.keio.ac.jp
Tsuji
Tetsuya
T
Liu
Meigen
M
Hase
Kimitaka
K
Tanaka
Naofumi
N
Fujiwara
Toshiyuki
T
D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D014741:Video Recording