title: Systematic review and meta-analysis of the diagnostic accuracy of the water swallow test for screening aspiration in stroke patients.
abstract: OBJECTIVE
  The aim of this study was to determine the diagnostic accuracy of the water swallow test for screening aspirations in stroke patients.
  
  
  BACKGROUND
  The water swallow test is a simple bedside screening tool for aspiration among stroke patients in nursing practice, but results from different studies have not been combined before.
  
  
  METHODS
  A systematic review and meta-analysis was conducted to provide a synthetic and critical appraisal of the included studies.
  
  
  METHODS
  Electronic literature in MEDLINE, EMBASE, CINAHL and other sources were searched systemically in this study. Databases and registers were searched from inception up to 30 April 2015.
  
  
  METHODS
  This systematic review was conducted using the recommendations from Cochrane Collaboration for Systematic Reviews of Diagnostic Test Accuracy. Bivariate random-effects models were used to estimate the diagnostic accuracy across those studies. The tool named Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to evaluate the quality of the studies.
  
  
  RESULTS
  There were 770 stroke patients in the 11 studies for the meta-analysis. The water swallow test had sensitivities between 64-79% and specificities between 61-81%. Meta-regression analysis indicated that increasing water volume resulted in higher sensitivity but lower specificity of the water swallow test.
  
  
  CONCLUSIONS
  This systematic review showed that the water swallow test was a useful screening tool for aspiration among stroke patients. The test accuracy was related to the water volume and a 3-oz water swallow test was recommended for aspiration screening in stroke patients.
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Po-Cheng
authors.initials: PC
authors.lastname: Chen
authors.affiliation: College of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan. chinhui@cgmh.org.tw.|Department of Nursing, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Taiwan. chinhui@cgmh.org.tw.
authors.forename: Ching-Hui
authors.initials: CH
authors.lastname: Chuang
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Chau-Peng
authors.initials: CP
authors.lastname: Leong
authors.affiliation: Chronic Diseases and Health Promotion Research Center, Chiayi, Taiwan.|College of Nursing and Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chiayi, Taiwan.
authors.forename: Su-Er
authors.initials: SE
authors.lastname: Guo
authors.affiliation: Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan.
authors.forename: Yi-Jung
authors.initials: YJ
authors.lastname: Hsin
mesh_terms: D003679:Deglutition; D003680:Deglutition Disorders / Q000175:diagnosis*; D006801:Humans; D011015:Pneumonia, Aspiration / Q000517:prevention & control; D012680:Sensitivity and Specificity; D020521:Stroke / Q000150:complications*; D014867:Water
chemical_list: D014867:Water
keywords: aspiration; nursing; stroke; systematic review and meta-analysis; water swallow test