Screening tests for aphasia in patients with stroke: a systematic review.
Aphasia has a large impact on the quality of life and adds significantly to the costs of stroke care. Early recognition of aphasia in stroke patients is important for prognostication and well-timed treatment planning. We aimed to identify available screening tests for differentiating between aphasic and non-aphasic stroke patients, and to evaluate test accuracy, reliability, and feasibility. We searched PubMed, EMbase, Web of Science, and PsycINFO for published studies on screening tests aimed at assessing aphasia in stroke patients. The reference lists of the selected articles were scanned, and several experts were contacted to detect additional references. Of each screening test, we estimated the sensitivity, specificity, likelihood ratio of a positive test, likelihood ratio of a negative test, and diagnostic odds ratio (DOR), and rated the degree of bias of the validation method. We included ten studies evaluating eight screening tests. There was a large variation across studies regarding sample size, patient characteristics, and reference tests used for validation. Many papers failed to report on the consecutiveness of patient inclusion, time between aphasia onset and administration of the screening test, and blinding. Of the three studies that were rated as having an intermediate or low risk of bias, the DOR was highest for the Language Screening Test and ScreeLing. Several screening tools for aphasia in stroke are available, but many tests have not been verified properly. Methodologically sound validation studies of aphasia screening tests are needed to determine their usefulness in clinical practice.
Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.|Rijndam Rehabilitation Institute, Rotterdam, The Netherlands.
Hanane
H
El Hachioui
Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. e.visch-brink@erasmusmc.nl.
Evy G
EG
Visch-Brink
Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.|Department of Neurology, Slotervaart Medical Center, Amsterdam, The Netherlands.
Lonneke M L
LM
de Lau
Rijndam Rehabilitation Institute, Rotterdam, The Netherlands.|Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Mieke W M E
MW
van de Sandt-Koenderman
Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.|Rijndam Rehabilitation Institute, Rotterdam, The Netherlands.
Femke
F
Nouwens
Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Peter J
PJ
Koudstaal
Department of Neurology, Erasmus MC University Medical Center, Room EE 2291, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Diederik W J
DW
Dippel
D001037:Aphasia / Q000175:diagnosis* / Q000209:etiology*; D006801:Humans; D020521:Stroke / Q000150:complications* / Q000175:diagnosis
Aphasia; Cerebrovascular disease/stroke; Diagnostic test assessment; Infarction; Intracerebral hemorrhage; Screening test