Published Online
on April 3, 2003

A more recent version of this article appeared on May 1, 2003

This Article Full Text (PDF) All Versions of this Article: 34/5/1252    most recent 01.STR.0000066309.06490.B8v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ramsey, D. J.C. Articles by Kalra, L. Search for Related Content PubMed PubMed Citation Articles by Ramsey, D. J.C. Articles by Kalra, L. Pubmed/NCBI databases Medline Plus Health Information Stroke Swallowing Disorders Related Collections Acute Stroke Syndromes Rehabilitation, Stroke Other Stroke Treatment - Medical

Submitted on November 21, 2002
Accepted on November 25, 2002

Early Assessments of Dysphagia and Aspiration Risk in Acute Stroke Patients

Deborah J.C. Ramsey MRCP^*; David G. Smithard MD; and Lalit Kalra PhD

From the Department of Stroke Medicine, Guy's King's & St. Thomas' School of Medicine, King's College, London (D.J.C.R., L.K.), and Health Care of Older People Department, William Harvey Hospital, Ashford, Kent (D.J.C.R., D.G.S.), UK.

^* To whom correspondence should be addressed. E-mail: deborah.ramsey{at}kcl.ac.uk.

Background and Purpose--Dysphagia is common after stroke and is a marker of poor prognosis. Early identification is important. This article reviews the merits and limitations of various assessment methods available to clinicians.

Methods--An electronic database search was performed of MEDLINE, EMBASE, and the Cochrane database using such terms as stroke, aspiration, dysphagia, and assessment; extensive manual searching of articles was also conducted.

Results--Bedside tests are safe, relatively straightforward, and easily repeated but have variable sensitivity (42% to 92%), specificity (59% to 91%), and interrater reliability (=0 to 1.0). They are also poor at detecting silent aspiration. Videofluoroscopy gives anatomic and functional information and allows testing of therapeutic techniques. However, swallowing is assessed under ideal conditions that are different from clinical settings, and reliability is often poor (=0 to 0.75) in the absence of assessor training. Fiberoptic endoscopy allows swallow assessment and sensory testing but requires specialized staff and equipment. Oxygen desaturation during swallowing may be predictive of aspiration (sensitivity, 73% to 87%; specificity, 39% to 87%) but is more useful in combination with bedside testing than in isolation. Other methods of swallow testing are invasive and require specialized staff and equipment.

Conclusions--Although bedside tests remain an important early screening tool for dysphagia and aspiration risk, further refinements are needed to improve their accuracy.

Key words: aspiration • deglutition disorders • dysphagia • process assessment (health care) • stroke

This article has been cited by other articles:

				C. A. Smith Hammond, L. B. Goldstein, R. D. Horner, J. Ying, L. Gray, L. Gonzalez-Rothi, and D. C. Bolser Predicting Aspiration in Patients With Ischemic Stroke: Comparison of Clinical Signs and Aerodynamic Measures of Voluntary Cough Chest, March 1, 2009; 135(3): 769 - 777. [Abstract] [Full Text] [PDF]

				T. Warnecke, I. Teismann, S. Oelenberg, C. Hamacher, E. B. Ringelstein, W. R. Schabitz, and R. Dziewas The Safety of Fiberoptic Endoscopic Evaluation of Swallowing in Acute Stroke Patients Stroke, February 1, 2009; 40(2): 482 - 486. [Abstract] [Full Text] [PDF]

				F. Harraf, K. Ward, W. Man, G. Rafferty, K. Mills, M. Polkey, J. Moxham, and L. Kalra Transcranial magnetic stimulation study of expiratory muscle weakness in acute ischemic stroke Neurology, December 9, 2008; 71(24): 2000 - 2007. [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]

				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]