Which screening tool should be used for identifying aspiration risk associated with dysphagia in acute stroke? A Cochrane Review summary with commentary.

Abstract

Dysphagia is a common impairment in patients with acute stroke and is associated with an increased risk of complications such as aspiration pneumonia, malnutrition and dehydration, as well as with poor outcome and higher mortality. Therefore, immediate screening for aspiration risk is recommended, using a bedside swallow screening tool. To determine the diagnostic accuracy and the sensitivity and specificity of bedside screening tests for detecting risk of aspiration associated with dysphagia in people with acute stroke. A summary of the Cochrane Review by Boaden et al. 2021, with comments from a rehabilitation perspective. The review included 25 studies with 3953 participants and 37 screening tests. No single study demonstrated 100% sensitivity and specificity with low risk of bias for all domains. The best performing swallow screening tools were the Bedside Aspiration test (combined water swallow and instrumental tool), the Gugging Swallowing Screen (GUSS, water plus other consistencies) and the Toronto Bedside Swallowing Screening Test (TOR-BSST, water only). However, these tests were based on single studies with small sample sizes. It was not possible to explore the influence of sources of heterogeneity. No single swallow screening tool with high accuracy as well as good quality evidence could be identified, but recommendations for further high-quality research are offered.