title: A simple bedside stroke dysphagia screen, validated against videofluoroscopy, detects dysphagia and aspiration with high sensitivity.
abstract: BACKGROUND
  Early identification of dysphagia is associated with lower rates of pneumonia after acute stroke. The Barnes-Jewish Hospital Stroke Dysphagia Screen (BJH-SDS) was previously developed as a simple bedside screen performed by nurses for sensitive detection of dysphagia and was previously validated against the speech pathologist's clinical assessment for dysphagia. In this study, acute stroke patients were prospectively enrolled to assess the accuracy of the BJH-SDS when tested against the gold standard test for dysphagia, the videofluoroscopic swallow study (VFSS).
  
  
  METHODS
  Acute stroke patients were prospectively enrolled at a large tertiary care inpatient stroke unit. The nurse performed the BJH-SDS at the bedside. After providing consent, patients then underwent VFSS for determination of dysphagia and aspiration. The VFSS was performed by a speech pathologist who was blinded to the results of the BJH-SDS. Sensitivity and specificity were calculated. Pneumonia rates were assessed across the 5-year period over which the BJH-SDS was introduced into the stroke unit.
  
  
  RESULTS
  A total of 225 acute stroke patients were enrolled. Sensitivity and specificity of the screen to detect dysphagia were 94% and 66%, respectively. Sensitivity and specificity of the screen to detect aspiration were 95% and 50%, respectively. No increase in pneumonia was identified during implementation of the screen (P = .33).
  
  
  CONCLUSIONS
  The BJH-SDS, validated against videofluoroscopy, is a simple bedside screen for sensitive identification of dysphagia and aspiration in the stroke population.
authors.affiliation: Department of Rehabilitation, Barnes-Jewish Hospital, St Louis, Missouri. Electronic address: jme0544@bjc.org.
authors.forename: Jeff
authors.initials: J
authors.lastname: Edmiaston
authors.affiliation: Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri; Department of Radiology, Washington University School of Medicine, St Louis, Missouri; Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Lisa Tabor
authors.initials: LT
authors.lastname: Connor
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Karen
authors.initials: K
authors.lastname: Steger-May
authors.affiliation: Department of Neurology, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Andria L
authors.initials: AL
authors.lastname: Ford
mesh_terms: D000328:Adult; D000368:Aged; D003679:Deglutition / Q000502:physiology; D003680:Deglutition Disorders / Q000175:diagnosis* / Q000209:etiology; D005006:Ethnicity; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011015:Pneumonia, Aspiration / Q000175:diagnosis* / Q000209:etiology; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D020521:Stroke / Q000150:complications*; D014741:Video Recording
keywords: Stroke; aspiration; dysphagia; pneumonia; screening test
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