Age and Ageing 2000; 29: 495-499
© 2000, British Geriatrics Society
Research papers |
The combination of bedside swallowing assessment and oxygen saturation monitoring of swallowing in acute stroke: a safe and humane screening tool
Departments of Speech and Language Therapy and
1 Radiology, Manchester Royal Infirmary, Manchester, UK
2 Department of Geriatric Medicine, Manchester University and
3 Platt Rehabilitation Unit 2, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
Abstract
Background: dysphagia is common in acute stroke. Accurate detection of the presence or absence of aspiration by bedside swallowing assessment is difficult without objective methods, tending to over-diagnose aspiration. As a result, some patients suffer restricted oral intake unnecessarily.
Objective: we examined the predictive values of pulse oximetry and speech and language therapy bedside swallowing assessment in the detection of aspiration compared with videofluoroscopy.
Design: a double-blind observational study.
Setting: two university teaching hospitals.
Subjects: we studied 53 patients whose acute strokes were confirmed by computed tomography scan.
Methods: Each subject had initial standard bedside swallowing assessment, closely followed by simultaneous and mutually blinded pulse oximetry, swallowing assessment and videofluoroscopy.
Results: 15 of 53 subjects aspirated. Bedside swallowing assessment and saturation assessment at 
2% desaturation gave good sensitivity (80% and 87% respectively), but low positive predictive values (50% and 36% respectively). Both assessments mistook laryngeal penetration for aspiration. Re-analysis with aspiration±penetration as a new endpoint improved bedside swallowing assessment positive predictive values to 83% (
2=3.59, P=0.032). Sensitivity of saturation assessment was maintained at 86%, positive predictive values of saturation assessment improved to 69% (2=6.74, P=0.009). The combination of bedside swallowing assessment and saturation assessment versus aspiration±penetration gave a positive predictive value of 95%.
Conclusions: screening by saturation assessments detects 86% of aspirators/penetrators and should be followed immediately by bedside swallowing assessment, as the combination of the two assessments gives the best positive predictive value. For patients with acute stroke, we advocate a 10 ml water-swallow screening test with simultaneous pulse oximetry by suitably trained medical and nursing staff. Use of this screening test would improve dysphagia detection whilst minimizing unnecessary restriction of oral intake in stroke patients.
Keywords: cerebrovascular disease, dysphagia, oxygen saturation
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Cabre, M. Serra-Prat, E. Palomera, J. Almirall, R. Pallares, and P. Clave Prevalence and prognostic implications of dysphagia in elderly patients with pneumonia Age Ageing, June 26, 2009; (2009) afp100v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T Warnecke, I Teismann, W Meimann, S Olenberg, J Zimmermann, C Kramer, E B Ringelstein, W R Schabitz, and R Dziewas Assessment of aspiration risk in acute ischaemic stroke--evaluation of the simple swallowing provocation test J. Neurol. Neurosurg. Psychiatry, March 1, 2008; 79(3): 312 - 314. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Trapl, P. Enderle, M. Nowotny, Y. Teuschl, K. Matz, A. Dachenhausen, and M. Brainin Dysphagia Bedside Screening for Acute-Stroke Patients: The Gugging Swallowing Screen Stroke, November 1, 2007; 38(11): 2948 - 2952. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. C. Ramsey, D. G. Smithard, and L. Kalra Can Pulse Oximetry or a Bedside Swallowing Assessment Be Used to Detect Aspiration After Stroke? Stroke, December 1, 2006; 37(12): 2984 - 2988. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Singh and S Hamdy Dysphagia in stroke patients. Postgrad. Med. J., June 1, 2006; 82(968): 383 - 391. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. M. McMahon, D. L. Hurley, P. S. Kamath, and P. S. Mueller Medical and Ethical Aspects of Long-term Enteral Tube Feeding Mayo Clin. Proc., November 1, 2005; 80(11): 1461 - 1476. [Abstract] [PDF]
|
|
|
|
|
|
P. W. Duncan, R. Zorowitz, B. Bates, J. Y. Choi, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, and D. Reker Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline Stroke, September 1, 2005; 36(9): e100 - e143. [Full Text] [PDF]
|
|
|
|
|
|
C. Roffe, S. Sills, M. Halim, K. Wilde, M. B. Allen, P. W. Jones, and P. Crome Unexpected Nocturnal Hypoxia in Patients With Acute Stroke Stroke, November 1, 2003; 34(11): 2641 - 2645. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J.C. Ramsey, D. G. Smithard, and L. Kalra Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients Stroke, May 1, 2003; 34(5): 1252 - 1257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Roffe, S. Sills, K. Wilde, and P. Crome Effect of Hemiparetic Stroke on Pulse Oximetry Readings on the Affected Side Stroke, August 1, 2001; 32(8): 1808 - 1810. [Abstract] [Full Text] [PDF]
|
|