Can bedside assessment reliably exclude aspiration following acute stroke?
OBJECTIVE
To investigate the ability of a bedside swallowing assessment to reliably exclude aspiration following acute stroke.


METHODS
Consecutive patients admitted within 24 h of stroke onset to two hospitals.


METHODS
A prospective study. Where possible, all patients had their ability to swallow assessed on the day of admission by both a doctor and a speech and language therapist using a standardized proforma. A videofluoroscopy examination was conducted within 3 days of admission.


RESULTS
94 patients underwent videofluoroscopy; 20 (21%) were seen to be aspirating, although this was not detected at the bedside in 10. In 18 (22%) of the patients the speech and language therapist considered the swallow to be unsafe. In the medical assessment, 39 patients (41%) had an unsafe swallow. Bedside assessment by a speech and language therapist gave a sensitivity of 47%, a specificity of 86%, positive predictive value (PPV) of 50% and a negative predictive value (NPV) of 85% for the presence of aspiration. Multiple logistic regression was used to identify the optimum elements of the bedside assessments for predicting the presence of aspiration. A weak voluntary cough and any alteration in conscious level gave a sensitivity of 75%, specificity of 72%, PPV of 41% and NPV of 91% for aspiration.


CONCLUSIONS
Bedside assessment of swallowing lacks the necessary sensitivity to be used as a screening instrument in acute stroke, but there are concerns about the use of videofluoroscopy as a gold standard. The relative importance of aspiration and bedside assessment in predicting complications and outcome needs to be studied.
Smithard
D G
DG
University Department of Geriatric Medicine, Speech and Language Therapy, Withington Hospital, Manchester, UK.
O'Neill
P A
PA
Park
C
C
England
R
R
Renwick
D S
DS
Wyatt
R
R
Morris
J
J
Martin
D F
DF
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000000981:diagnostic imaging* / Q000209:etiology*; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000000981:diagnostic imaging* / Q000209:etiology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications*; D014743:Videotape Recording