Abstract
Background: The importance of screening for dysphagia in stroke patients is well established, yet an optimal tool has not been identified. The CCW (cough on command, control of saliva and water swallow) Swallow Screen builds on existing data for item selection. Purpose: The purpose of the study was to compare the CCW Swallow Screen against the Gold Standard speech language pathology (SLP) swallow evaluation for detection of dysphagia in acute stroke patients. Methods: Using the CCW Swallow Screen and SLP swallow evaluation outcome measures, a prospective correlation study was performed on a sample of 88 acute stroke patients (SEM = 1.63). Inclusion required passing the CCW pre-screen component: be alert, follow commands and sit up. SLP swallow evaluation was completed within 3 hours after the nurse administered CCW screen, to support criterion-related validity. Data analysis included sensitivity and specificity, and positive (+LR) and negative (-LR) likelihood ratios. Specific statistics generated included chi-square (χ2), correlation (Phi ≥ .80). Inter-rater reliability (IRR) was supported by prior training, testing and competency validation of nurses, plus performance monitoring during data collection. IRR was computed with Cohen’s kappa. Results: The CCW Swallow Screen correctly detected the presence and absence of dysphagia, (Sensitivity = 84%; Specificity = 95%) and demonstrated a strong certainty that dysphagia was present or not present (+LR = 16.8; -LR = 0.17). A statistically significant association between the CCW Swallow Screen and the SLP evaluation (χ2 (1) = 56.66, p < .001) indicated that the CCW Swallow Screen and the SLP evaluation equally measured dysphagia in this stroke sample. The association between the two tests was found to be strong (Phi = .80). IRR results revealed zero variance as both raters observed and passed all nurses in perfect agreement (IRR = 1) for competency validation and data collection observation. Conclusion: The CCW Swallow Screen is a reliable, valid tool for detection of dysphagia in acute stroke patients. The simplicity of the tool supports feasibility in a variety of clinical settings. Further validation with a similar sample is warranted.
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